EXPRESS Order Form For USA and International Orders

TAB between fields. Left click to select. * required *E-mail Address: *First Name: *Last Name: *Title: *Company: MS/Floor/Bldg.: *Address: *City: *State/Province: --- Select State ---  Outside U.S./Canada AL Alabama AK Alaska AB Alberta AS American Samoa AZ Arizona AR Arkansas BC British Columbia CA California CO Colorado CT Connecticut DE Delaware DC District of Columbia FM Micronesia FL Florida GA Georgia GU Guam HI Hawaii ID Idaho IL Illinois IN Indiana IA Iowa KS Kansas KY Kentucky LA Louisiana ME Maine MB Manitoba MH Marshall Islands MD Maryland MA Massachusetts MI Michigan MN Minnesota MS Mississippi MO Missouri MT Montana NE Nebraska NV Nevada NB New Brunswick NF Newfoundland NH New Hampshire NJ New Jersey NM New Mexico NY New York NC North Carolina ND North Dakota MP Northern Marianas NT Northwest Territories NS Nova Scotia OH Ohio OK Oklahoma ON Ontario OR Oregon PW Palau PA Pennsylvania PE Prince Edward Island PR Puerto Rico QC Quebec RI Rhode Island SK Saskatachewan SC South Carolina SD South Dakota TN Tennessee TX Texas UT Utah VT Vermont VI Virgin Islands VA Virginia WA Washington WV West Virginia WI Wisconsin WY Wyoming YT Yukon *Postal Code: Country: --- Select Country ---  American Samoa Argentina Australia Austria Bahamas Bahrain Barbados Belgium Bermuda Bolivia Brazil Canada Cayman Islands Chile China Colombia Costa Rica Denmark Dominican Republic Ecuador Egypt El Salvador Fiji Finland France Germany Guam Guatemala Haiti Hong Kong Iceland India Indonesia Ireland Italy Jamaica Japan Jordan Lebanon Luxembourg Malaysia Malta Mexico Morocco Netherlands New Zealand Norway Panama Papua New Guinea Paraguay Peru Philippines Portugal Puerto Rico Saudi Arabia Singapore South Africa South Korea Spain Sri Lanka Sweden Switzerland Taiwan Thailand Trinidad and Tobago Turkey United Arab Emirates United Kingdom United States Uruguay Venezuela Vietnam Western Samoa *Telephone Fax Payment Method: Mastercard VISA American Express Card Number: Example: 123456789... Expiration: Month  01 02 03 04 05 06 07 08 09 10 11 12 Year  1999 2000 2001 2002 2003 2004 2005 *Please send: Information only USA: 1 Demo kit $120.00 +$6.00 S&H Save over 54% USA: 2 Demo kits $240.00 +$8.00 S&H Int'l: 1 Demo kit USD120.00 +USD35.00 S&H Save over 54% Int'l: 2 Demo kits USD240.00 +USD55.00 S&H Priority Shipping: USA: UPS Next Day Air® +$20.00 Int'l: UPS Express® +USD45.00 Comment:

©1997 The Carpenter Group, USA. All Rights Reserved. GloveLock &; GloveLock2 are trademarks of The Carpenter Group, USA.