SoldierCity, Inc.
1001 Lower Landing Rd #407
Blackwood, NJ 08012
http://www.soldiercity.com/
Full Name________________________________________________________________________

E-mail_________________________________ Phone_______________ Fax_________________

Address 1________________________________________________________________________

Address 2________________________________________________________________________

City_________________________________________________  State______ ZIP___________


   Stock#     Quantity     Description     Size   Color   Price Each  Total Price

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Shipping & Handling:                                         Sub Total___________

    Domestic and APO/FPO         Canada        Less Any Credit/Coupons___________
                                               (Coupon No:___________)
Under $15.00 . . . . . $4.95   Call/Email
$15.00 to $25.00 . . . $5.95   for Rates           Shipping & Handling___________
$25.01 to $35.00 . . . $6.95                       (See Chart Opposite)
$35.01 to $50.00 . . . $7.95
$50.01 to $75.00 . . . $8.95             NJ Residents add 7% Sales Tax___________
$75.01 to $100.00  . . $9.95             (on applicable items)
$100.01 to $150.00 . . $10.95
$150.01 to $200.00 . . $11.95                                    Total___________
Over $200.00 . . Call/Email for Rates

                                                             
Payment Method:  _____Check/M.O. _____Visa _____MasterCard _____American Express

Credit Card Number_____________________________________ Expiration Date_____

Name as it appears on the card______________________________________________

Cardholder Signature________________________________________________________