Name                   Date    

Address 

City        State         Zip Code   -

Telephone  not required

E-Mail Address    Fax # not required

Send To information if different than above or for orders and shipments outside  the United States

Items you wish to purchase :

       Specimen #      Name                                                            Price

                                                                                                Total  

Shipping -  All items will be shipped by the U.S. Postal Service's Priority Shipping.

       U.S. Postal Service   

Payment - Remember, the total payment includes the items purchased and the exact shipping charge and 5% sales tax for Maryland residents.

       Check      Money Order      Visa       Master Card

      For Credit Card orders:   Name on Card   

                               Card #              Exp. Date                                      

Special instructions area