Gift Order, or Ship To: (only if not the same)
Name:__________________________________
Address:___________________________________
City/State/Zip:_____________________________________________
Phone: (..........) ___________________

Quantity

________# MAGK1 ($12.75 each).....*......Total__________
________# MAGK2 ($3.00 each).......^......Total__________
________# MAG25A($21.50 each)....*......Total__________
________# MAG252 ($26.75 each)....*......Total__________

Sub Total.............................................................__________

Tax: Add 8% Sales Tax if ordered in NY State...__________

Shipping: $2.00 per item, plus $3.30 per order, up to $12 Maximum

Orders for foreign address shipping will be modified to the cost of Flat Rate Priority Mail rates appropriate to the order size. Grand Total........................................................__________

Visa / Mastercard Orders:

Card Number:   ____________________________________
Expiration Date: __________
Security Code : __________
(last three digits of the number on the back side of the card)