Email Address:________________________________________________

First Name:___________________Last Name:_______________________

Street Address:________________________________________________

P.O. Box or Suite/Lot Number:____________________________________

City:__________________________________State:__________________

Zip/Postal Code:____________________Country:____________________

Telephone Number:_(____)_____________Fax Number:_(____)______________

Section 2

Is the shipping address the same as the information above?

Yes_____ or No_____

If yes, skip this section and go to section number 3 below.
If no, please enter the shipping address information below:

First Name:___________________Last Name:_______________________

Street Address:________________________________________________

P.O. Box or Suite/Lot Number:____________________________________

City:__________________________________State:__________________

Zip/Postal Code:____________________Country:____________________

Telephone Number:_(____)_____________Fax Number:_(____)______________

Section 3

Items or Services you are ordering:

Part Number:___________ Description:_________________________
Quantity:________Price Each:$___________Total Price:$___________

Part Number:___________ Description:_________________________
Quantity:________Price Each:$___________Total Price:$___________

Part Number:___________ Description:_________________________
Quantity:________Price Each:$___________Total Price:$___________

Part Number:___________ Description:_________________________
Quantity:________Price Each:$___________Total Price:$___________

$__________Subtotal
$__________Sales Tax (GA residents ONLY include 7% sales tax)
$__________Shipping & Handling Charges - See your quote
Canadian & Overseas customers: inquire about shipping costs before ordering
Specify Standard, Priority, Overnight, or Other (circle one)
$__________Insurance ($2.30 per $100.00 of merchandise)
$__________Payment Total

Section 4

Please make all payments out to THIS OLD TOY:

Payment by Money Order will insure that your order is shipped immediately. Please allow 2-3 weeks for a personal check to clear.
Canadian and Overseas Buyers: payment must be made to us in US Funds, and drawn on a US Bank. This means that Postal Money Orders from Canada or Overseas do NOT qualify, since the funds are not DRAWN from a US Bank. If you choose to remit payment via a Canadian or Overseas Postal Money Order, you must include an extra $25.00 US for out-of-country collection fees that are charged for such service.
Please do NOT send cash to us!

Personal Check: #___________________
Money Order: #_____________________
Other (specify method):__________________________________

Section 5

Thank you for your order! Please double-check all of your entries for completeness and correctness! We will notify you via email (if possible) when we receive and ship your merchandise.