| Item: | _______________________________________ | Price: | $____.____ |
| Item: | _______________________________________ | Price: | $____.____ |
| Item: | _______________________________________ | Price: | $____.____ |
| Shipping Charge (See Schedule Below): | ______ | : | $____.____ |
| Name: | ___________________________________________________ |
| Address: | ___________________________________________________ |
| City, State, Zip: | ___________________________________________________ |
| Phone: | ___________________________________________________ |
| Checks/Money order made out to Chess Star Co. | Or... | Circle One: ![]() |
| Account Number: | ___________________________________ | Exp.Date: | ________ |
| Signature: | ___________________________________ | Date: | ________ |