California-Antilles Trading Consortium  http://www.calantilles.com 
3735 Adams Ave.
San Diego, CA 92116
Tel/Fax (619) 283-4834

Ordered by:

Name____________________________________
Address _________________________________
Apt/Suite No._________
City_______________State_____Zip__________
Phone Number (___)_______________________
Email Adress_____________________________ (optional)
        
Ship to: (Use only if different from "Ordered by")

Name____________________________________
Address__________________________________
Apt/Suite No.________
City______________State____Zip_____________
Phone Number (___)________________________

Credit Card Number ____________________________  (Please Print Legibly!)

Please Check Credit Card Type:

_Master Card   _Visa   _Diners  _JCB    Expiration Date ___/___ Ex. 00/00

Signature X__________________________________________ 
(A signature is necessary for credit card orders!

PLEASE PRINT CLEARLY

 QTY |  ITEM NO.|               DESCRIPTION OF ITEM                  |   PRIC    | TOTAL  |
 
 ____|________|__________________________________|_______|_______|
 ____|________|__________________________________|_______|_______|
 ____|________|__________________________________|_______|_______|
 ____|________|__________________________________|_______|_______|
 ____|________|__________________________________|_______|_______|
 ____|________|__________________________________|_______|_______|
	
		Subtotal .......................................................................|_______|                                                              
		(CA residents add 7.75% Sales Tax) ......................|_______|
		Shipping and Handling ..............................................|_______|                                 
		Grand Total .................................................................|_______|                                     
 
					  
Shipping & Handling Charges
Up to $15.00          	  $5.50
$15.01 to $30.00   	  $7.00
$30.01 to $50.00        $8.60
Over $50.00                $10.00

Method of Payment:  No COD's

Make Check or Money Order Payable To:

California-Antilles Trading Consortium
3735 Adams Ave.
San Diego, CA  92116

619-283-4834
Toll Free Ordering 1-800-330-6450

Form Updated  2-12-08