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ORDER FORM

888-992-9696

This form can be used to fax in an order to R & I. All information is confidential. You will receive an e-mail acknowledgment of receipt of this order. Enter your personal information below.

Name:__________________________________

Phone(day):______________________________

Shipping Address:________________________________

_______________________________________________

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Method of Payment(visa, mastercard, discover, american express)

Card Number____________________________ Expiration date________

Special Instructions

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TOTAL PURCHASE $__________

** SHIPPING IS $8.50 ON ALL STANDARD GROUND ORDERS TO ANYWHERE IN THE CONTINENTAL USA. OVERNIGHT, 2ND DAY, 3RD DAY OR Shipping to Alaska or Hawaii or to locations OUTSIDE THE USA ARE OPEN TO CASE BY CASE CHARGES