SHIP THIS ORDER TO:
Name ______________________________ Company Name ___________________________
Address ____________________________________________________________________
____________________________________________________________________________
City ___________________ State _____ Zip ___________ Country _______________
Phone __________________ FAX ______________________ Email __________________
QTY. STOCK # DESCRIPTION EACH TOTAL
___|__________|__________________________________________|________|_________
___|__________|__________________________________________|________|_________
___|__________|__________________________________________|________|_________
___|__________|__________________________________________|________|_________
___|__________|__________________________________________|________|_________
___|__________|__________________________________________|________|_________
___|__________|__________________________________________|________|_________
___|__________|__________________________________________|________|_________
___|__________|__________________________________________|________|_________
___|__________|__________________________________________|________|_________
SHIPPING
Orders placed with credit card will be charged Subtotal |_________
actual shipping charges. It is not necessary to
enter a shipping charge on the order form. Shipping |_________
CREDIT CARD INFORMATION
Card Number ____________________________ 6% PA Sales Tax |_________
Billing Address (if different from above) Total |_________
________________________________________
________________________________________
Signature ______________________________
Exp. Date __________ Visa, MasterCard or American Express
SHIPPING INFORMATION
Continental United States - please specify if you have a preferred method of
shipment, otherwise we will ship via UPS Ground.
International - Global Express Mail, UPS and FedEx service are available.
Please specify your preference, otherwise we will ship
via most economical method.