Checkout

Please complete the form below. To submit your order click on the 'Submit Order' button. Please note that you may choose any of the payment methods and you do not need to fill in a credit card number if using a payment method other than credit card. Also, you may print this form and fax it to us at 540-582-2876 if you prefer. Actual shipping charges will apply. 5% sales tax applied to orders from Virginia residents.

Shipping Information:
First Name:
Last Name:
Address 1:
Address 2:
City:
State:
ZIP/Postal Code:
Email Address:
Phone:

Billing Information:
Same as Shipping Information
First Name:
Last Name:
Address 1:
Address 2:
City:
State:
ZIP/Postal Code:
Email Address:
Phone:

Payment Details:
Payment Method:	Visa Master Card Discover Check Money Order
Name on Card:
Card Number:
Expiration (Month/Year):
3 Digit Code

Comments: