"); cWin.document.write("
"); cWin.document.write("Email:
"); cWin.document.write("Billing Address :"); cWin.document.write("NAME:"); cWin.document.write("Street Address: "); cWin.document.write("City: "); cWin.document.write("State: "); cWin.document.write("Zip Code: "); cWin.document.write("Telephone: "); cWin.document.write("Fax:
"); cWin.document.write("Shipping Address(Optional) :"); cWin.document.write("NAME:"); cWin.document.write("Street Address: "); cWin.document.write("City: "); cWin.document.write("State: "); cWin.document.write("Zip Code: "); cWin.document.write("Telephone: "); cWin.document.write("Fax: "); cWin.document.write("Shipping Method:"); cWin.document.write("Select Method"); cWin.document.write("Same Day($20.95)"); cWin.document.write("Next Day($10.95)"); cWin.document.write("2nd Day($7.95)"); cWin.document.write("3 Day($3.95)"); cWin.document.write("Purchase Total = $ Including shipping"); cWin.document.write("Credit Card Type: ** "); cWin.document.write("Credit Card #: ** "); cWin.document.write("Expiration Date: ****Optional! Your inputs are NOT encrypted. You can leave ** blank. We will confirm these information with you through phone. Alternatively you can select to print this order form and fax it to fax:(510)536-4428."); cWin.document.write(" "); cWin.document.write(" "); cWin.document.write("
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