Order Form

Fell Free to print this out and send it in with payment

                              use ($.$$)

Item 1 X Qty Total1$

Item 2  X Qty Total2$

Item 3 X Qty Total3 $

Item 4 X Qty Total4 $

Item 5  X QtyTotal5 $

Item 6  X QtyTotal6 $

Item 7 X Qty Total7 $

Item 8 X Qty Total8 $

Item 9 X QtyTotal9 $

Item 10 X QtyTotal10 $

Shipping Method + $ (shipping total)

                                               Florida Residents pleas add   6% Sales Tax

                                                                     Grand Total  $

Send To:

First Name

Last Name

Address1  

Address2  

City          

State

ZIP

Phone #  -- (example: 456-555-3423)

E-MAIL Address

Payment Type :    Check        Money Order

               Enter Check Number you will use (short number from top)

               Enter Money Order # if known

   I   (<= State your Name) will be mailing my payment to:

Aquatic Dragon

P.O. Box 541822

Lake Worth, FL 33454-1822

   On  (Mailing date) to process my order and shipped to MY address above.

Comments & Questions about your Order (Please fill out Name/e-mail address first):

 

All orders will be sent on reception of payment

Please Include Name & Address info with payment mailed

You will be notified by e-mail if there are any changes