Quantity	Item Number	Description	Size	Second Choice	Price Each	Total
Quantity	Item Number	Description	Size	Second Choice	Price Each	Total
Quantity	Item Number	Description	Size	Second Choice	Price Each	Total
Quantity	Item Number	Description	Size	Second Choice	Price Each	Total
Quantity	Item Number	Description	Size	Second Choice	Price Each	Total
					Subtotal
					8.25 sales tax (NY Residents)
					XXLG size +$1.00 each
					Shipping Charges
					Total

Domestic Shipping Charges (see chart below)
Overseas shipping add 25% of total order
Allow 3 - 5 weeks for delivery
Make check or money order payable to INDOMOTION
U.S. Funds only

Merchandise Total	Shipping
Up to $20.00	$ 5.00
$20.01 to $40.00	$ 6.25
$40.01 to $60.00	$ 7.75
$60.01 to $80.00	$ 9.75
$80.01 to $100.00	$ 12.00
$100.01 to $150.00	$ 14.00
$150.01 to $200.00	$ 16.00
$200.01 to $250.00	$ 18.00

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Shipping Information

NAME

ADDRESS

CITY STATE ZIP COUNTRY
PHONE DATE

CREDIT CARD Visa Mastercard American Express NUMBER

Expiration Date E-Mail Address