The On-Line Massage    Store Order Form


Send To: The On-Line Massage Supply Store
               C/O  THE CMI
	       1933 E. Frankford RD
	       Suite# 140
	       Carrollton, TX
	       75007

Checks and Credit Card Orders Only (No Cash)

|         Item #           | Quanity |  Price      |  Color (if applicable)
|                          |         |             |                      |
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If more room is needed please use the back of this form and include all the 
information pertaining to the item ordered.

Credit card orders must include the following: 
 

 Account #:________________________________                                                                                                                         
 

 Name(as it appears on card):__________________________
 
 
Expiration date:__________
 
 
Signature:________________________

 
Daytime Phone #:____________________



(Send to) 

Your Name:
              
Address:
             
City:
      
State:

Zip Code:


Thank you for your patronage!!!!!