Ship's Log Deluxe Order Form

Please provide the following contact information:

      First name 
       Last name 
          E-mail 

Please provide the following order information:

QTY     Item
 

                 SHIPPING
  Street address 
 Address (cont.) 
            City 
  State/Province 
 Zip/Postal code 
         Country 

I have enclosed $93.95 ($89.95 + $4.00 shipping) for each item.

I am a Washington resident, and have enclosed $101.70

	 ($89.95 + $4.00 shipping + $7.75 Tax*) for each item.

*Washington State Residents must include 8.6% sales tax (calculated above).