PRINT THIS FORM and mail it . . . or
Call, e-mail or FAX Jennifer with your orders,
Monday through Friday, 9 a.m. to 3 p.m. EST.
E-Mail: locotzinc@embarqmail.com        TELEPHONE: 239-283-5599
FAX:239-283-0532    Toll-Free 1-866-456-2687

ORDER FORM  from  Sanibel Biological Supply
____ # of  DARK LIGHT  HAT(s)              @  $21.00 =
 
$ _____
     
   
[shipping and handling fee ...]
  
$ 4.95
Florida Residents add 6% Sales Tax:
    
$ _____
TOTAL =
  
$ _____

 
ship to:      name: _____________________________

   address:    ____________________________________

                         ____________________________________

                         ____________________________________

                         ____________________________________

                    (MASTERCARD or VISA only)
Credit Card # ______________________ exp date ___/_____

Name (as it appears on card) ________________________

VCODE (3 digit verification code on back on card) [ _ _ _ ]

Card Billing Address: (SAME as shipping address above?) ____ Yes

   ___________________________

   ___________________________

   ___________________________

Make check to:  Sanibel Biological Supply
Send Check or Money Order :

Sanibel Biological Supply
5576 Doug Taylor Circle
St. James City, FL 33956