For shipping add : in USA $5.50-Canada $7.00
Master Card or Visa #__________________________________ EXP.Date________
Signature:_____________________________
Make check payable to: Siroflex Products
Mail to: Siroflex Products, 8974 Felipe Avenue
Montclair, CA 91763-1403
Name______________________________
Address____________________________
City___________________ State ____Zip________
E-mail:________________________
Phone:________________________
Siroflex Products will NOT sell, trade or rent to third parties
your personal information whole or part.
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