Print out this form and fax to 617 387-7894

IMPORTANT: When Ordering  Page __________ OF __________
1. Please supply all information requested, especially recipient's zip code and phone number.
2. Please verify all delivery address data.
3. No P.O. boxes please. Street addresses or rural route numbers only.
4. Order by gift name and Item number.
5. Please type or print clearly.

Step 1. Billing Information

Name__________________________________________________________________________

Company_______________________________________________________________________

Address________________________________________________________________________

City_________________________________State_________________Zip___________________

Day Phone_________________________ Evening Phone_________________________________

Email Address___________________________________________________________________

Step 2. Indicate Your payment Preference
Charge to
VISA MasterCard Discover American Express

Credit Card Holder Name___________________________________

Credit Card Number_______________________________________

Expiration Date___________________________________________

Credit Card Signature______________________________________

Step 3. Itemize Gift Purchases

Item No.	Item Description	Qty	Price	Shipping	Total Price