The Spirit of Lo Secure Online Order Form

Customer Name * (*Denotes Required Field )
Number of Copies X 14.95 *	Total Book Price $
Oklahoma Residents Sales Tax Add $1.19 per book Number of Books 1 2 3 4 5 6 7 8 9 10 OK Sales Tax 1.19 2.38 3.57 4.76 5.95 7.14 8.33 9.52 10.71 11.90	Total Oklahoma Sales Tax $
Shipping & Handling Charges $3.95 for the 1st book $2.95 for each additional book Number of Books 1 2 3 4 5 6 7 8 9 10 S&H 3.95 6.90 9.85 12.80 15.75 18.70 21.65 24.60 27.55 30.50	Total S&H Charges $ *
	Total Amount Due: $

Customer Information
Full Name	*(Denotes Required Field)
Address	*
City, State & Zip	*
E-mail Address	*
(Area Code)Phone Number	( ) * *
Credit Card Type	Visa Master Card (You must select One)
Credit Card Number (Numbers Only, no dashes)	- - - *
Credit Card Expiration Date (MM/YY)	*
Name as it appears on Credit Card	*

If shipping address is different than the address stated above, please insert the shipping address in the space provided to the left.