Purchaser's Full Name: __________________________________________
Mailing Address: _______________________________________________
City: _____________________________  State/Province: ______________
Country: ______________________     ZIP/Postal Code: ________________
E-Mail Address (Optional): _________________________________________
Best Phone Number (extension, if applicable): ___________________  ext. _____
Amount Of Gift Certificate (in U.S. Dollars):  $________________ (e.g., $100.00)

IF THIS IS A GIFT OR FOR SOMEONE ELSE, PLEASE FILL IN BELOW:

Recipient's Name: ______________________________________________
Recipient's Mailing Address: ______________________________________
Recipient's City: ______________________ State/Province: _____________
Recipient's Country: _______________  ZIP/Postal Code: ________________

( ) Check here if you want US to send Gift Certificate to recipient.
( ) Check here if you want us to send the Gift Certificate to you.

PAYMENT OPTION:  ( ) Check      ( ) Credit Card.  <--- Please check one.
If credit card, please check card type: ( ) VISA     ( ) MasterCard     ( ) Discover
Credit Card Number: ___________________________
Expiration Date: Month _________  Year ___________
Exact Name On Credit Card: ______________________

Please print out form, complete fully, enclose payment or credit card information and mail
to the address at the top of the form.  We accept only the credit cards mentioned on this page.
Please make  sure that you print a copy for your records.  Please print legibly to avoid
delays.