Innovative Products Distributing, Inc. Offering Bright Ideas and Superior Products

<body background="../images/bg.gif"> <center> <TABLE WIDTH="475"> <TR> <TD valign=top align=center> <img src="../images/innoanimate.gif" width="209" height="137"> </td> <td align=center> <img src="../images/order.gif" width="135" height="86"> </td> </tr> </table> </center> <center> <TABLE WIDTH="475"> <TR> <TD valign=top align=center> <img src="../images/terryanimate.gif" width="470" height="62"> </td> </tr> </table> </center> <center> <TABLE WIDTH="500"> <tr> <td> <h5>If you are interested in placing an order on our secure form, please complete the form below and Press the "submit" button.<br> If you prefer, you may fill out the form, print it out and<a href="../contact.html" target="bigframe"> fax</a> or<a href="../contact.html" target="bigframe"> call us</a> toll free with your information. All information provided will be kept confidential.<br><br>Once your order has been submitted, you will receive an order confirmation via e-mail within 24 hours. If you have placed an order and do not receive an order confirmation, please <a href="../contact.html" target="bigframe">contact us</a>. </h5> </td><td valign=top><img src="../images/verisign1.gif" width="100" height="144"></td> </tr> <tr> <td colspan=2 align=center> <img src="../images/divider.gif" width="395" height="10"> </td> </tr> </table> </center> <FORM METHOD="POST" ACTION="FormResults.asp"> <CENTER> <table width="500" border="0" cellspacing="0" cellpadding="0"> <tr> <td colspan="4" align=center bgcolor="gold"> <h4>Billing Information</h4> </td> <tr> <td align="RIGHT"> <FONT SIZE="1">*Name </font> </TD> <TD colspan=3>  <INPUT TYPE="text" NAME="name" maxlength=50 VALUE="" SIZE=50 MAXLENGTH=50> </TD> </TR> <TR> <TD align=right> <FONT SIZE="1">*Address</FONT> </TD> <TD colspan=3>  <INPUT TYPE="text" NAME="address" maxlength=50 VALUE="" SIZE=50 MAXLENGTH=50> </TD> </TR> <TR> <TD align=right> <FONT SIZE="1" >*State</FONT> </TD> <TD>  <SELECT NAME="state" SIZE=1> <OPTION VALUE="">Click to Select <OPTION VALUE="OT">Other (not in USA) <OPTION VALUE="AL">Alabama <OPTION VALUE="AK">Alaska <OPTION VALUE="AZ">Arizona <OPTION VALUE="AR">Arkansas <OPTION VALUE="CA">California <OPTION VALUE="CO">Colorado <OPTION VALUE="CT">Connecticut <OPTION VALUE="DE">Delaware <OPTION VALUE="DC">District of Columbia <OPTION VALUE="FL">Florida <OPTION VALUE="GA">Georgia <OPTION VALUE="HI">Hawaii <OPTION VALUE="ID">Idaho <OPTION VALUE="IL">Illinois <OPTION VALUE="IN">Indiana <OPTION VALUE="IA">Iowa <OPTION VALUE="KS">Kansas <OPTION VALUE="KY">Kentucky <OPTION VALUE="LA">Louisiana <OPTION VALUE="ME">Maine <OPTION VALUE="MD">Maryland <OPTION VALUE="MA">Massachusetts <OPTION VALUE="MI">Michigan <OPTION VALUE="MN">Minnesota <OPTION VALUE="MS">Mississippi <OPTION VALUE="MO">Missouri <OPTION VALUE="MT">Montana <OPTION VALUE="NE">Nebraska <OPTION VALUE="NV">Nevada <OPTION VALUE="NH">New Hampshire <OPTION VALUE="NJ">New Jersey <OPTION VALUE="NM">New Mexico <OPTION VALUE="NY">New York <OPTION VALUE="NC">North Carolina <OPTION VALUE="ND">North Dakota <OPTION VALUE="OH">Ohio <OPTION VALUE="OK">Oklahoma <OPTION VALUE="OR">Oregon <OPTION VALUE="PA">Pennsylvania <OPTION VALUE="RI">Rhode Island <OPTION VALUE="SC">South Carolina <OPTION VALUE="SD">South Dakota <OPTION VALUE="TN">Tennessee <OPTION VALUE="TX">Texas <OPTION VALUE="UT">Utah <OPTION VALUE="VT">Vermont <OPTION VALUE="VA">Virginia <OPTION VALUE="WA">Washington <OPTION VALUE="WV">West Virginia <OPTION VALUE="WI">Wisconsin <OPTION VALUE="WY">Wyoming </SELECT> </TD> <TD ALIGN=RIGHT> <FONT SIZE="1">*City</FONT> </TD> <TD> <INPUT TYPE="text" NAME="city" maxlength=10 VALUE="" SIZE=18> </TD> </TR> <TR> <TD align="RIGHT"> <FONT SIZE="1" >*ZIP Code</FONT> </TD> <TD>   <INPUT TYPE="text" NAME="zipcode" maxlength=10 VALUE="" SIZE=18> </TD> <TD ALIGN=RIGHT> <FONT SIZE="1">Country</FONT> </TD> <TD> <INPUT TYPE="text" NAME="country" maxlength=10 VALUE="" SIZE=18> </TD> </TR> <TR> <TD align=right> <FONT SIZE="1">Email</FONT> </TD> <TD>  <INPUT TYPE="text" NAME="email" SIZE=18 MAXLENGTH="80"> </TD> <TD ALIGN=RIGHT> <FONT SIZE="1">*Phone </FONT> </TD> <TD> <INPUT TYPE="text" NAME="phone" VALUE="" SIZE=18 MAXLENGTH=20> </TD> </TR> <tr> <TD align="right"><FONT SIZE="1">*Card</FONT> </TD> <TD>  <SELECT NAME="card" SIZE="1"> <OPTION VALUE="">Click to Select <OPTION VALUE="AmeEx">American Express <OPTION VALUE="Discover">Discover <OPTION VALUE="Master Card">Master Card <OPTION VALUE="Visa">Visa </select> </TD> <td align="RIGHT"> <FONT SIZE="1">*Card #</FONT> </TD> <TD> <INPUT TYPE="text" NAME="cardnumber" maxlength="20" VALUE="" SIZE="18" MAXLENGTH="30"> </TD> </tr> <tr> <td align=center> <FONT SIZE="1">*Exp. Date</FONT> </TD> <TD>  <INPUT TYPE="text" NAME="expdate" maxlength="5" VALUE="" SIZE="5" MAXLENGTH="5"> </TD><td colspan=2><font size="2">*Indicates required fields</td> </TR> <tr><td colspan="4" align=center bgcolor="gold"><h4>Shipping Information - <input type="checkbox" name="sameasbilling" value ="Same As Billing">Click if same as billing</h4></td> </tr> <TR> <TD align="right"> <FONT SIZE="1">Address</FONT> </TD> <TD>  <INPUT TYPE="text" NAME="shippingaddress" maxlength="30" VALUE="" SIZE="18" MAXLENGTH="30"> </TD> <td align="RIGHT"> <FONT SIZE="1">P.O. Box </FONT> </TD> <TD> <INPUT TYPE="text" NAME="shippingpobox" maxlength="30" VALUE="" SIZE="18" MAXLENGTH="25"> </TD> </TR> <tr> <TD align="right"><FONT SIZE="1">State</FONT> </TD> <TD>  <SELECT NAME="shippingstate" SIZE="1"> <OPTION VALUE="">Click to Select <OPTION VALUE="OT">Other (not in US A) <OPTION VALUE="AL">Alabama <OPTION VALUE="AK">Alaska <OPTION VALUE="AZ">Arizona <OPTION VALUE="AR">Arkansas <OPTION VALUE="CA">California <OPTION VALUE="CO">Colorado <OPTION VALUE="CT">Connecticut <OPTION VALUE="DE">Delaware <OPTION VALUE="DC">District of Columbia <OPTION VALUE="FL">Florida <OPTION VALUE="GA">Georgia <OPTION VALUE="HI">Hawaii <OPTION VALUE="ID">Idaho <OPTION VALUE="IL">Illinois <OPTION VALUE="IN">Indiana <OPTION VALUE="IA">Iowa <OPTION VALUE="KS">Kansas <OPTION VALUE="KY">Kentucky <OPTION VALUE="LA">Louisiana <OPTION VALUE="ME">Maine <OPTION VALUE="MD">Maryland <OPTION VALUE="MA">Massachusetts <OPTION VALUE="MI">Michigan <OPTION VALUE="MN">Minnesota <OPTION VALUE="MS">Mississippi <OPTION VALUE="MO">Missouri <OPTION VALUE="MT">Montana <OPTION VALUE="NE">Nebraska <OPTION VALUE="NV">Nevada <OPTION VALUE="NH">New Hampshire <OPTION VALUE="NJ">New Jersey <OPTION VALUE="NM">New Mexico <OPTION VALUE="NY">New York <OPTION VALUE="NC">North Carolina <OPTION VALUE="ND">North Dakota <OPTION VALUE="OH">Ohio <OPTION VALUE="OK">Oklahoma <OPTION VALUE="OR">Oregon <OPTION VALUE="PA">Pennsylvania <OPTION VALUE="RI">Rhode Island <OPTION VALUE="SC">South Carolina <OPTION VALUE="SD">South Dakota <OPTION VALUE="TN">Tennessee <OPTION VALUE="TX">Texas <OPTION VALUE="UT">Utah <OPTION VALUE="VT">Vermont <OPTION VALUE="VA">Virginia <OPTION VALUE="WA">Washington <OPTION VALUE="WV">West Virginia <OPTION VALUE="WI">Wisconsin <OPTION VALUE="WY">Wyoming </SELECT> </TD><TD align="right"> <FONT SIZE="1">City </FONT> </TD> <TD> <INPUT TYPE="text" NAME="shippingcity" maxlength="30" VALUE="" SIZE="18" MAXLENGTH="30"> </TD> </tr> <tr> <td colspan=2 align=right> <FONT SIZE="1">Please fill in if your Country if outside the USA</FONT></td> <TD ALIGN=RIGHT> <FONT SIZE="1">Country</FONT> </TD> <TD> <INPUT TYPE="text" NAME="shippingcountry" maxlength=10 VALUE="" SIZE=18> </TD> </TR> <tr> <TD align="right"> <FONT SIZE="1">ZIP Code</FONT> </TD> <TD>  <INPUT TYPE="text" NAME="shippingzipcode" maxlength="10" VALUE="" SIZE="18"> </TD> <TD align="right"> <FONT SIZE="1">Contact Person</FONT> </TD> <TD> <INPUT TYPE="text" NAME="shippingcontact" SIZE="18" MAXLENGTH="80"> </TD> </tr></table></center> <center> <table width="500" cellspacing=0 cellpadding=0 border=0> <tr> <td colspan=2 align=center bgcolor="gold"><h4>Product Order</H4></td> </tr> <tr> <td><SELECT NAME="cribtent" SIZE=1> <OPTION VALUE ="">Quantity <OPTION VALUE ="1">1 <OPTION VALUE ="2">2 <OPTION VALUE ="3">3 <OPTION VALUE ="4">4 <OPTION VALUE ="5">5 </SELECT> </TD> <td><h4>Cozy Crib Tent - $60.00 plus $5.95 S&H ea. </td> </tr> <tr> <td><SELECT NAME="playardtent" SIZE=1> <OPTION VALUE ="">Quantity <OPTION VALUE ="1">1 <OPTION VALUE ="2">2 <OPTION VALUE ="3">3 <OPTION VALUE ="4">4 <OPTION VALUE ="5">5 </SELECT> </TD> <td><h4>Cozy Portable Playard Tent Plus Cabana Kit - $60.00 plus <br>5.95 S&H ea.</td> </tr> <tr> <td><SELECT NAME="bugnet" SIZE=1> <OPTION VALUE ="">Quantity <OPTION VALUE ="1">1 <OPTION VALUE ="2">2 <OPTION VALUE ="3">3 <OPTION VALUE ="4">4 <OPTION VALUE ="5">5 </SELECT> </TD> <td><h4>Baby's Bug Net - $19.95 plus $4.00 S&H ea.</td> </tr> <tr> <td><SELECT NAME="pouch" SIZE=1> <OPTION VALUE ="">Quantity <OPTION VALUE ="1">1 <OPTION VALUE ="2">2 <OPTION VALUE ="3">3 <OPTION VALUE ="4">4 <OPTION VALUE ="5">5 </SELECT> </TD> <td><h4>Baby's All in One Portable Pouch - $9.95 plus $4.00 S&H ea.</td> </tr> <tr> <td><SELECT NAME="beachballbag" SIZE=1> <OPTION VALUE ="">Quantity <OPTION VALUE ="1">1 <OPTION VALUE ="2">2 <OPTION VALUE ="3">3 <OPTION VALUE ="4">4 <OPTION VALUE ="5">5 </SELECT> </TD> <td><h4>Towel Bag - Beach Ball - $19.95 plus $4.00 S&H ea.</td> </tr> <tr> <td><SELECT NAME="bingobag" SIZE=1> <OPTION VALUE ="">Quantity <OPTION VALUE ="1">1 <OPTION VALUE ="2">2 <OPTION VALUE ="3">3 <OPTION VALUE ="4">4 <OPTION VALUE ="5">5 </SELECT> </TD> <td><h4>Towel Bag - Bingo - $19.95 plus $4.00 S&H ea.</td> </tr> <tr> <td><SELECT NAME="21bag" SIZE=1> <OPTION VALUE ="">Quantity <OPTION VALUE ="1">1 <OPTION VALUE ="2">2 <OPTION VALUE ="3">3 <OPTION VALUE ="4">4 <OPTION VALUE ="5">5 </SELECT> </TD> <td><h4>Towel Bag - Blackjack (21) - $19.95 plus $4.00 S&H ea.</td> </tr> <tr> <td><SELECT NAME="characterbag" SIZE=1> <OPTION VALUE ="">Quantity <OPTION VALUE ="1">1 <OPTION VALUE ="2">2 <OPTION VALUE ="3">3 <OPTION VALUE ="4">4 <OPTION VALUE ="5">5 </SELECT> </TD> <td><h4>Towel Bag - Character - $19.95 plus $4.00 S&H ea.</td> </tr> <tr> <td><SELECT NAME="checkerbag" SIZE=1> <OPTION VALUE ="">Quantity <OPTION VALUE ="1">1 <OPTION VALUE ="2">2 <OPTION VALUE ="3">3 <OPTION VALUE ="4">4 <OPTION VALUE ="5">5 </SELECT> </TD> <td><h4>Towel Bag - Checker - $19.95 plus $4.00 S&H ea.</td> </tr> <tr> <td><SELECT NAME="roulettebag" SIZE=1> <OPTION VALUE ="">Quantity <OPTION VALUE ="1">1 <OPTION VALUE ="2">2 <OPTION VALUE ="3">3 <OPTION VALUE ="4">4 <OPTION VALUE ="5">5 </SELECT> </TD> <td><h4>Towel Bag - Roulette - $19.95 plus $4.00 S&H ea.</td> </tr> <tr> <td><SELECT NAME="crapsbag" SIZE=1> <OPTION VALUE ="">Quantity <OPTION VALUE ="1">1 <OPTION VALUE ="2">2 <OPTION VALUE ="3">3 <OPTION VALUE ="4">4 <OPTION VALUE ="5">5 </SELECT> </TD> <td><h4>Towel Bag - Craps - $19.95 plus $4.00 S&H ea.</td> </tr> <tr> <td><SELECT NAME="vsggoldwhite" SIZE=1> <OPTION VALUE ="">Quantity <OPTION VALUE ="1">1 <OPTION VALUE ="2">2 <OPTION VALUE ="3">3 <OPTION VALUE ="4">4 <OPTION VALUE ="5">5 </SELECT> </TD> <td><h4>VSG 2PK - Gold/White - $4.95 plus $3.00 S&H ea.</td> </tr> <tr> <td><SELECT NAME="vsgbluewhite" SIZE=1> <OPTION VALUE ="">Quantity <OPTION VALUE ="1">1 <OPTION VALUE ="2">2 <OPTION VALUE ="3">3 <OPTION VALUE ="4">4 <OPTION VALUE ="5">5 </SELECT> </TD> <td><h4>VSG 2PK - Blue/White - $4.95 plus $3.00 S&H ea.</td> </tr> <tr> <td><SELECT NAME="vsgredwhite" SIZE=1> <OPTION VALUE ="">Quantity <OPTION VALUE ="1">1 <OPTION VALUE ="2">2 <OPTION VALUE ="3">3 <OPTION VALUE ="4">4 <OPTION VALUE ="5">5 </SELECT> </TD> <td><h4>VSG 2PK - Red/White - $4.95 plus $3.00 S&H ea.</td> </tr> <tr> <td><SELECT NAME="vsggreenwhite" SIZE=1> <OPTION VALUE ="">Quantity <OPTION VALUE ="1">1 <OPTION VALUE ="2">2 <OPTION VALUE ="3">3 <OPTION VALUE ="4">4 <OPTION VALUE ="5">5 </SELECT> </TD> <td><h4>VSG 2PK - Green/White - $4.95 plus $3.00 S&H ea.</td> </tr> <tr> <td colspan=2 align=center bgcolor="gold"><h5>We use UPS ground shipping to ship our orders. <br>Interested in Priority Shipping? Call 1-877-890-9006 for Pricing and information</H4></td> </tr> </table> </center> <center><BR> <input TYPE="submit" VALUE="Submit Form"> <input TYPE="reset" NAME="Clear" VALUE="Clear Form"> </center> </FORM> <center><table width="485" cellspacing="0"><tr><td align="center"><h6><a href="../index.html" target="_top">Home</a>|<a href="../tots" target="_top">Tots in Mind </a>|<a href="../terrytravel" target="_top">Terry Travel </a>|<a href="../visor" target="_top">Visor Sport Guard </a>|<a href="https://www.innovativedist.com/form/index.html" target="_top">Order Online</a>|<a href="../contact.html" target="bigframe">Contact Us</a></h6></td></tr></table></center><br><center><table width=500><tr><td align=center><h5><font color="#000084">©1999, all rights reserved</h5></font></td></tr></table></center></center></body>