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 $7.50 ON ORDERS under $200 TO ANYWHERE IN THE CONTINENTAL USA. Shipping to Alaska or Hawaii or to locations OUTSIDE THE USA WILL BE DONE BY CHEAPEST METHOD POSSIBLE **