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To establish an account, please print out this form and provide the following information:

Name ____________________________________________ Tel: __________________________

Address _________________________________________________________________________

City, State, Zip Code _____________________________________________________________

Email address: ___________________________________________________________________

Credit Card number: _______________________________Exp. Date: ____________________

Signature___________________________________________________(for fax or mail applications)

___________ I am 18 or older (initials, please).

Under most circumstances, you can expect a same day response to your fax in the form of an email. Once your account has been confirmed and you have received your password, you may place an order at your convenience.

Our Fax number is 541-298-5171.

If you experience any difficulty in this process at any time, please call us at 541-296-4342. Our office hours are 10am-5:30pm, PDT, seven days a week.