Order Information
Phone:  (917) 560-2959
Fax:   Print this form and fax it to (888) excite2 ext 800 jimames

Terms & Conditions
100% satisfaction policy.  Credit card orders only.

Shipping Information
UPS ground and 2nd day air

SECURE Order Form - (SSL - Secure Sockets L ayer)

Product	Item	Description	Price	Qty.	Total
				Subtotal
				Tax
				Total

Shipping Address - We will NEVER make your address available to ANYONE!

Name
Address
City		State
Country		Zip
Email

Billing Address
  Check if same as shipping address

Name
Address
City		State
Country		Zip
Email

Billing Information - Secure - SSL

Credit card
Name on Card
Card number
Expiration