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Straightforward 11918 Millpond Court Manassas, VA 22111-3283
Phone - 1.703.791.6421 Fax - 1.703.791.6522

Name:_________________________________________________________________

Street:_______________________________________________________________

City:___________________________________  State:______________________

Zip:____________________________________  Phone:______________________


Qty    Code              Description                           Amount
______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

                                              Subtotal:_______________

                              Less any discount/credit:_______________

                           Virginia Residents add 4.5%:_______________

             First Class Shipping and Handling - $6.50:_______________

Subtotal over $50/100 add $2/4 for additional shipping:_______________

                        UPS Second Day Air - Add $6.00:_______________

                         UPS Next Day Air - Add $15.00:_______________

                                        Total Enclosed:_______________

Make payment payable to Straightforward.  U.S. funds only.
Payment Method: (circle one)

Check      Money Order      VISA      Mastercard

Card #:_____________________________________ Exp. Date:_______________

Signature:____________________________________________________________

For checks, please provide your Driver License number and your phone
number for approval.  The delivery address must match the address on
your check.