DARKSTAR'S ORDER FORM

Print out the following order form and either:

1. Phone In : 1-877-DARKSTAR

2. Fax it to :  1-877-DARKSTAR

3. Mail it to:
   Snail mail it to:
   DarkStar-INC
   650 Cheirwood Rd 
   Pulaski Pa 16143

Make Checks or Money Orders Payable to Timothy R Chito

You will receive a response within 24 hours from when we receive your order. (weekends and holidays excluded)
Email: _________________________
Company (optional): ______________
Address: ______________________
State: __________
Country: ____________
Zip: _________
Phone: (___) ____- ______
Items and Quantity: _____________________________________________________________________
Total: _______________________
I am enclosing a check or money order. Please note at we do not accept checks by fax, so if you are paying by check or money order you must mail it in to the address above.
I want to charge this purchase to my Credit Card

Credit Card (check one):

[ ] VISA
[ ] MasterCard
[ ] American Express
[ ] Discover
[ ] Card Number: _________________________   Security Code on The Back of the Card ______________It is 3 numbers. Unless AMEX

Expiration Date: _______

Signature: _____________________________

I authorize DarkStar-INC to charge my credit card for this purchase.
Your Bill will reflect a Charge From CCnow not DarkStar.
They are our Merchant Service.