|  | 
 
   
                   
                    
                    
                      |  |  
                      |  | Thank you for your 
                        order. Your web confirmation number is 57567.
 |  
                      |  |  
                      | 
                          
                          
                            | 
                                
                                
                                | Billing Address |  
                                |  |  
                                | First Name: | Robert |  
                                | Last 
                                Name: |  |  
                                | Company: |  |  
                                | Address: |  |  
                                |  |  |  
                                | City: | where-I-live |  
                                |  | CA |  
                                | Zip 
                                Code: |  |  
                                | Country: | United States |  
                                | Phone: | my-Oakland-voicemail-number |  
                                | E-Mail: | http://dummy.us.eu.org/robert |  | 
                                
                                
                                | Shipping Address |  
                                |  |  
                                | Same as Bill To 
                                Address |  |
 |  
                          
                          
                            | Item | Qty | Description | Discount | Total |  
                            | SRNG0103F | 1 | SLEEP 
                              RIGHT NIGHT GUARD | -- | $69.95 |  
                          
                          
                            | Subtotal: | $69.95 |  
                            | (National,State and Local 
                              taxes)  Tax: | $0.00 |  
                            | Shipping: (Via: UPS)
 | $9.75 |  
                            | 
 |  
                            | TOTAL: | $79.70 |  |  
                      |  |  
                      |  |  
                      |  | If you would like to register 
                        with us, please enter a password and click the 
                        'Register' button. By registering, you will be able 
                        to check on your order status on-line.
 If you do not 
                        wish to register, click on the 'Complete Order' 
                      button.
 |  
                      |  |  
                      |  | Password |  
                      |  | Re-Enter 
                        Password |  
                      |  |   |  
                      |  |  
                      |  |  |  |  |  |