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<!-- There is absolutely no magic to this...this is a standard HTML form.
The only thing of note is that it references html_web_store.cgi-->
<HTML>
<HEAD>
<TITLE>Standard Order Form</TITLE>
</HEAD>
<BODY BGCOLOR="#ffffff">
<FORM ACTION = "web_store.cgi" METHOD = "post">
<H2>CART CONTENTS HERE</H2>
<CENTER>
<TABLE WIDTH="550" BORDER="0" CELLPADDING="0">
<TR>
<TD COLSPAN="2"><FONT SIZE="-1"><HR></FONT></TD>
</TR>
<TR BGCOLOR="FFFFCC">
<TD COLSPAN="2"><FONT SIZE="+1">Customer Information:</FONT></TD>
</TR>
<TR>
<TD COLSPAN="2"><FONT SIZE="-1"><HR></FONT></TD>
</TR>
<TR>
<TD WIDTH=100>First Name</TD>
<TD WIDTH=450><INPUT TYPE="text" NAME="01-fname" SIZE="30" MAXLENGTH="30"></TD>
</TR>
<TR>
<TD>Last Name</TD>
<TD><INPUT TYPE="text" NAME="02-lname" SIZE="30" MAXLENGTH="30"></TD>
</TR>
<TR>
<TD COLSPAN="2"><FONT SIZE="-1"><HR></FONT></TD>
</TR>
<TR BGCOLOR="FFFFCC">
<TD COLSPAN="2"><FONT SIZE="+1">Billing Address:</FONT></TD>
</TR>
<TR>
<TD COLSPAN="2"><FONT SIZE="-1"><HR></FONT></TD>
</TR>
<TR>
<TD WIDTH=100>Street:</TD>
<TD WIDTH=450><INPUT TYPE="text" NAME="03-b_street_address" SIZE="30"></TD>
</TR>
<TR>
<TD WIDTH=100>City:</TD>
<TD WIDTH=450><INPUT TYPE="text" NAME="04-b_city" SIZE="30">
</TR>
<TR>
<TD WIDTH=100>State:</TD>
<TD WIDTH=450>
<SELECT NAME="05-b_state">
<OPTION>AK</OPTION>
<OPTION>AL</OPTION>
<OPTION>AR</OPTION>
<OPTION>AZ</OPTION>
<OPTION>CA</OPTION>
<OPTION>CO</OPTION>
<OPTION>CT</OPTION>
<OPTION>DC</OPTION>
<OPTION>DE</OPTION>
<OPTION>FL</OPTION>
<OPTION>GA</OPTION>
<OPTION>GU</OPTION>
<OPTION>HI</OPTION>
<OPTION>IA</OPTION>
<OPTION>ID</OPTION>
<OPTION>IL</OPTION>
<OPTION>IN</OPTION>
<OPTION>KS</OPTION>
<OPTION>KY</OPTION>
<OPTION>LA</OPTION>
<OPTION>MA</OPTION>
<OPTION>MD</OPTION>
<OPTION>ME</OPTION>
<OPTION>MI</OPTION>
<OPTION>MN</OPTION>
<OPTION>MO</OPTION>
<OPTION>MS</OPTION>
<OPTION>MT</OPTION>
<OPTION>NC</OPTION>
<OPTION>ND</OPTION>
<OPTION>NE</OPTION>
<OPTION>NH</OPTION>
<OPTION>NJ</OPTION>
<OPTION>NM</OPTION>
<OPTION>NV</OPTION>
<OPTION>NY</OPTION>
<OPTION>OH</OPTION>
<OPTION>OK</OPTION>
<OPTION>OR</OPTION>
<OPTION>PA</OPTION>
<OPTION>PR</OPTION>
<OPTION>RI</OPTION>
<OPTION>SC</OPTION>
<OPTION>SD</OPTION>
<OPTION>TN</OPTION>
<OPTION>TX</OPTION>
<OPTION>UT</OPTION>
<OPTION>VA</OPTION>
<OPTION>VI</OPTION>
<OPTION>VT</OPTION>
<OPTION>WA</OPTION>
<OPTION>WI</OPTION>
<OPTION>WV</OPTION>
<OPTION>WY</OPTION>
</SELECT>
</TR>
<TR>
<TD WIDTH=100>Zip:</TD>
<TD WIDTH=450><INPUT TYPE="text" NAME="06-b_zip" SIZE="11" MAXLENGTH="11"></TD>
</TR>
<TR>
<TD WIDTH=100>Country:</TD>
<TD WIDTH=450><INPUT TYPE="text" NAME="07-b_country" SIZE="11" MAXLENGTH="11"></TD>
</TR>
<TR>
<TD COLSPAN="2"><FONT SIZE="-1"><HR></FONT></TD>
</TR>
<TR BGCOLOR="FFFFCC">
<TD COLSPAN=2><FONT SIZE="+1">Shipping Address:</FONT></TD>
</TR>
<TR>
<TD COLSPAN="2"><FONT SIZE="-1"><hr></FONT></TD>
</TR>
<TR>
<TD WIDTH=100>Street:</TD>
<TD WIDTH=450><INPUT TYPE="text" NAME="08-m_street_adress" SIZE="30"></TD>
</TR>
<TR>
<TD WIDTH=100>City:</TD>
<TD WIDTH=450><INPUT TYPE="text" NAME="09-m_city" SIZE="30"></TD>
</TR>
<TR>
<TD WIDTH=100>State:</TD>
<TD WIDTH=450>
<SELECT NAME="10-m_state">
<OPTION>AK</OPTION>
<OPTION>AL</OPTION>
<OPTION>AR</OPTION>
<OPTION>AZ</OPTION>
<OPTION>CA</OPTION>
<OPTION>CO</OPTION>
<OPTION>CT</OPTION>
<OPTION>DC</OPTION>
<OPTION>DE</OPTION>
<OPTION>FL</OPTION>
<OPTION>GA</OPTION>
<OPTION>GU</OPTION>
<OPTION>HI</OPTION>
<OPTION>IA</OPTION>
<OPTION>ID</OPTION>
<OPTION>IL</OPTION>
<OPTION>IN</OPTION>
<OPTION>KS</OPTION>
<OPTION>KY</OPTION>
<OPTION>LA</OPTION>
<OPTION>MA</OPTION>
<OPTION>MD</OPTION>
<OPTION>ME</OPTION>
<OPTION>MI</OPTION>
<OPTION>MN</OPTION>
<OPTION>MO</OPTION>
<OPTION>MS</OPTION>
<OPTION>MT</OPTION>
<OPTION>NC</OPTION>
<OPTION>ND</OPTION>
<OPTION>NE</OPTION>
<OPTION>NH</OPTION>
<OPTION>NJ</OPTION>
<OPTION>NM</OPTION>
<OPTION>NV</OPTION>
<OPTION>NY</OPTION>
<OPTION>OH</OPTION>
<OPTION>OK</OPTION>
<OPTION>OR</OPTION>
<OPTION>PA</OPTION>
<OPTION>PR</OPTION>
<OPTION>RI</OPTION>
<OPTION>SC</OPTION>
<OPTION>SD</OPTION>
<OPTION>TN</OPTION>
<OPTION>TX</OPTION>
<OPTION>UT</OPTION>
<OPTION>VA</OPTION>
<OPTION>VI</OPTION>
<OPTION>VT</OPTION>
<OPTION>WA</OPTION>
<OPTION>WI</OPTION>
<OPTION>WV</OPTION>
<OPTION>WY</OPTION>
</SELECT></TD>
</TR>
<TR>
<TD WIDTH=100>Zip:</TD>
<TD WIDTH=450><INPUT TYPE="text" NAME="11-m_zip" SIZE="11" MAXLENGTH="11"></TD>
</TR>
<TR>
<TD WIDTH=100>Country:</TD>
<TD WIDTH=450><INPUT TYPE="text" NAME="12-m_country" SIZE="11" MAXLENGTH="11"></TD>
</TR>
<TR>
<TD COLSPAN="2"><FONT SIZE="-1"><hr></FONT></TD>
</TR>
<TR BGCOLOR="FFFFCC">
<TD COLSPAN="2"><FONT SIZE="+1">Phone/Email</FONT></TD>
</TR>
<TR>
<TD COLSPAN="2"><FONT SIZE="-1"><hr></FONT></TD>
</TR>
<TR>
<TD WIDTH=100>Phone:</TD>
<TD WIDTH=450><INPUT TYPE="text" NAME="13-phone" SIZE="15" MAXLENGTH="15"></TD>
</TR>
<TR>
<TD WIDTH=100>Fax:</TD>
<TD WIDTH=450><INPUT TYPE="text" NAME="14-fax" SIZE="15" MAXLENGTH="15"></TD>
</TR>
<TR>
<TD WIDTH=100>E-Mail:</TD>
<TD WIDTH=450><INPUT TYPE="text" NAME="15-e-mail" MAXLENGTH="30"></TD>
</TR>
<TR>
<TD COLSPAN="2"><FONT SIZE="-1"><hr></FONT></TD>
</TR>
<TR BGCOLOR="FFFFCC">
<TD COLSPAN="2"><FONT SIZE="+1">Credit Card Information:</FONT></TD>
</TR>
<TR>
<TD COLSPAN="2"><FONT SIZE="-1"><hr></FONT></TD>
</TR>
<TR>
<TD COLSPAN="2">
<INPUT TYPE="radio" NAME="18-type_of_card" VALUE="visa">Visa
<INPUT TYPE="radio" NAME="18-type_of_card" VALUE="mastercard">Mastercard
<INPUT TYPE="radio" NAME="18-type_of_card" VALUE="discover">Discover
<INPUT TYPE="radio" NAME="18-type_of_card" VALUE="amex">American Express
</TD>
</TR>
<TR>
<TD COLSPAN="2"><FONT SIZE="-1"> </FONT></TD>
</TR>
<TR>
<TD WIDTH=100>Card Name:</TD>
<TD WIDTH=450><INPUT TYPE="text" NAME="19-cardname" SIZE="30" MAXLENGTH="30"></TD>
</TR>
<TR>
<TD WIDTH=100>Number:</TD>
<TD WIDTH=450><INPUT TYPE="text" NAME="20-card_number" MAXLENGTH="20"></TD>
</TR>
<TR>
<TD WIDTH=100>Exp. Date:</TD>
<TD WIDTH=450><INPUT TYPE="text" NAME="21-ex_date" SIZE="10" MAXLENGTH="10"></TD>
</TR>
</TABLE>
</CENTER>
<p> </p>
<CENTER>
<P>
<P>
<font face=arial size=3>Please Allow 10 - 14 days for shipping</font>
<P>
<INPUT TYPE=reset NAME= " Reset ">
<INPUT TYPE=submit NAME = "submit_order_form_button" VALUE = " Submit Order "><BR>
</CENTER>
</FORM>
<CENTER><HR WIDTH=550></CENTER>
</BODY>
</HTML>