NAME
ADDRESS
CITY
STATE	AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MO MT NE NV NH NJ NM NY NC ND OH OR PA PR RI SC SD TN TX UT VT VA VI WA WV WI WY      Country
ZIP
PHONE
EMAIL
CARD	visa master amex
NUMBER
EXP	month jan feb mar apr may jun jul aug sep oct nov dec      year 98 99 00 01 02 03 04 05
ITEMS ORDERED
TOTAL	$
S/H	1-2 items add $4 3-4 items add $5 5-6 items add $6 more than 6 items call for price
TAX	NY residents add 8.25% all others no tax
TOTAL	$

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