NAME: CREDIT CARD BILING ADDRESS (If different from shipping)
SHIPPING ADDRESS:  
CITY/STATE/ZIP: CITY/STATE/ZIP:
PHONE: E-MAIL:
QTY
ITEM NUMBER
DESCRIPTION (Include size & color if applicable)
UNIT PRICE
TOTAL PRICE
     
         
         
         
         
         
         
         
         
   
1
Insurance
* Add Postal Insurance To My Order (Optional)
$1.85
  
1
Rush
* Rush My Order (Optional)
$3.95
  
Fax or E-Mail Your Order Anytime 24 Hours a Day!
( Please Circle Payment Method Below )
Visa CardMaster CardDiscover CardPersonal Check (For U.S. Customers Only!)Money Order or Bank Check in U.S. Funds
FAX: 305-238-4694 TOLL FREE IN THE U.S.A.: 1-800-471-3094
SUBTOTAL
 $

SHIPPING - See Rates Listed Below

 $
TAX - Florida Residents Please Add 7% Sales Tax $
TOTAL
 $
16 Digit Credit Card Number                                
Expiration Date (Required) Month: Year:

Last three numbers on back of card:
Cardholder Signature (Required For All Credit Card Orders)
Shipping Fees
Retail orders up to $9.99 add $3.95 shipping
 Retail orders of $50.00 - $99.99 add $7.95 shipping
Retail orders of $10.00 - $49.99 add $4.95 shipping Retail orders of $100.00 & above add $12.95 shipping
* International orders (Excluding Canada) add $4.00 to the shipping cost listed above to cover additional international shipping fees.
* * * Wholesale Orders Over $100 Add 7.5% Shipping * * *

* By MAIL: Send payment in U.S. funds to: Pinnacle Supplies CO. 17930 S.W. 134 CT. MIAMI, FL 33177 (Payable to: Patrick Escano)