SECURE ORDER FORM

SILESIA GROUP INC. , P.O. BOX 763, ELFERS, FL 34680, USA CONTACT

FAX ORDER TO : 1-773-767-7708, 1-800-6000-461


Name:
Address:
City:
State: Zip:
Phone:
E-mail:

 
 
Item No. Qty. Unit Price Total
  SHIPPING & HANDLING - USA - $6.00 

ORDERS ABOVE $40.00 PLEASE ADD 10% 
PLEASE ALLOW ONE WEEK FOR DELIVERY


Grand Total:  

Payment Information:

Money Order American ExpressVISA Mastercard

CC Number (Please list all digits from your charge card)

Expiration Date: 

THANK YOU FOR YOUR ORDER

Copyright (c) 1990 Silesia Group Inc. All rights reserved.

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