Standard Online Order Form

ORDERING INSTRUCTIONS:

To Order Using Your CHARGE CARD:
We accept VISA, MasterCard, Discover and American Express.

Please type in the necessary and required information.  When you have completed this, you may order using your charge card utilizing any one of the four following ways:

1) Submit your order electroncally by clicking on the "Send Order" button at the bottom of this page, or
2) Print all forms and MAIL to the address below, or
3) Print all forms and FAX or PHONE your order to: (208) 623-2400

(By submitting your order by any of the above methods, you authorize Lawicka to debit your credit  card for the items ordered on this form).

Thank you for your order!
 

Please enter your name and address as it is on file with your credit card company!    We can not process your order unless we can verify your address with your credit card company.

Fields marked with an * are REQUIRED to process your order.

Name: *

Street Address, line 1: *

Street Address, line 2:

City: *

State / Province*

Please select from list Alabama AlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces PacificArmed Forces EuropeArmed Forces Americas____________________AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest Territories Nova ScotiaOntarioPrince Edward Isl.QuebecSaskatchewanYukon Territory                      

Country*

Please select from list ____________________United StatesCanadaJapanUnited KingdomAustraliaGermanyFranceSwitzerlandItalyNetherlands____________________AlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarticaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBotswanaBouvet IslandBrazilBritish Indian Ocean Terr.Brunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslColombiaComorosCongoCook IslCosta RicaCote D'IvoireCroatiaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEstoniaEthiopiaFaeroe IslandsFalkland Isl. (Malvinas)FijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern Terr.GabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernsey, C.I.GuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslHondurasHong KongHungaryIcelandIndiaIndonesiaIrelandIsle of ManIsraelItalyJamaicaJapanJersey, C.I.JordanKazakhstanKenyaKiribatiKorea, Republic ofKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLiechtensteinLithuaniaLuxemborgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslMartiniqueMauritaniaMauritiusMexicoMicronesiaMoldova, Republic ofMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherland AntillesNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslNorthern Mariana IslNorwayOmanPakistanPalauPanamaPanama Canal ZonePapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts & NevisSaint LuciaSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSt. HelenaSt. Pierre and MiquelonSt. Vincent & GrenadinesSudanSurinameSvalbard & Jan Mayen IslSwazilandSwedenSwitzerlandTaiwanTajikistanTanzania, United Republic ThailandTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslTuvaluU.A.E.U.S.Minor Outlying IslUgandaUkraineUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican City StateVenezuelaViet NamVirgin Isl (British)Virgin Isl, (U.S.)Wallis & Futuna IslandsWestern SaharaYemen, Republic ofZaireZambiaZimbabwe                      

Zip / Postal Code: *

Day Phone (area code and phone number): *

Evening Phone (area code and phone number): *

Method of Payment: *

Name as it appears on Card: *

Credit Card Number (xxxx-xxxx-xxxx-xxxx): *

Exp. Date (mm/yy): *

E-mail Address:

All prices are in US dollars.

Comments (optional):

WARNING!
Credit card fraud is a felony and Lawicka will aggressively prosecute anyone attempting to misuse a credit card number. Lawicka tracks every transaction and will use all means available to it to prosecute persons attempting fraud.

All reports are 100% SATISFACTION GUARANTEED!

By clicking on the "Send Order" button below, I authorize Lawicka to debit my credit card for the items ordered on this form.

695 Eagle Drive, Spirit Lake, ID  83869-9690

24 Hour Voice: (208) 623-2400


© 2000 Lawicka, All rights reserved.