Ordered by:

First Name
Last Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

Shipping Address (if different):

	SHIP TO:
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Switchplate Style:    
(Available Styles)

Design: Clouds    Stars

Number:

Subtotal:
Single-sized Plates: $25.00
Double-Sized Plates: $30.00
Triple-Sized Plates: $35.00

Maryland residents add 5% sales tax.

Payment:

Paypal     Click here for our Paypal Order Form
Personal Check
    (order will ship AFTER payment clears)
Business Check
   (order will ship AFTER payment clears)
Money Order

Shipping: 10% of subtotal:

Total Payment: