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Credit Card Payment Instructions

We are working on adding "Shopping Cart" feature to our website as time from product production and new product design allows.
Till then please fill in the following fields, print this page and forward it with previuosly printed order page(s) to us by any of the following means:

Mail all pages to address below
Email to:  sales14@22lrconversions.com

Please remember "o/s" means the product is in OUT OF STOCK status.  Do NOT order it UNTIL the o/s is removed.  The order will be returned.

Order Total


From filled out order page

5% Credit Card Payment Surcharge


Credit Card Billing Total


Type of card (circle one) -  Master Card, Visa, Discover, American Express

Credit card number  -  _________    _________    _________    __________

Expiration date - ____________

Name as it appears on credit card  -  _________________________________________________

Numeric part of billing address of card  __________

Zip code of billing address of card  __________

3 digit security code on back of card -  ________

I, the undersigned, do agree to accept and abide by the conditions of the one year warrenty
included with the product.  Signed  ______________________________  Date  __________

Jonathan Arthur Ciener, Inc.
8700 Commerce Street    Cape Canaveral, FL 32920    321 868-2200    Fax  321 868-2201

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