Print this form then:  Fax or Mail Your Order   fax:1-630-898-6445 Date: ______________________ Name: ____________________________________________________________ Address: ____________________________________________________________   ___________________________________     City: ___________________________________ State: ___________________ Phone: ___________________________________ Zip: ___________________     Shipping address if other than above:   (P.O. Box Holders - Provide street address) Name: ____________________________________________________________ Address: ____________________________________________________________   ___________________________________     City: ___________________________________ State: ___________________     Zip: ___________________ Charge Card Information:              ____Visa        ____Mastercard       ___American Express Number:  _________________________________________________________________________ Expires:  _________________________________________________________________________ Print Cardholder Name  ____________________________________________________________ Cardholder Signature  ______________________________________________________________ _____________________________________________________________________ QTY MODEL # SIZE COLOR Item - Name/Description Total ____ ______ _______ _______ _______________________________________ ____________ ____ ______ _______ _______ _______________________________________ ____________ ____ ______ _______ _______ _______________________________________ ____________ ____ ______ _______ _______ ________________________________________ ____________ ____ ______ _______ _______ _______________________________________ ____________ ____ ______ _______ _______ _______________________________________ ____________ ____ ______ _______ _______ _______________________________________ ____________ ____ ______ _______ _______ _______________________________________ ____________ DiamondFireCZ sub total: ____________ 1375 Natalie Lane IL sales tax (7.5%): ____________ Aurora, IL 60504 Shipping and Handling: ____________ Local 630-898-6908  Toll Free 877-898-6908     Thank You For Your Order TOTAL: ____________