MAIL/FAX ORDER FORM
DATE
____________
NAME (please print)
____________________________________________________
STREET ADDRESS
____________________________________________________
CITY/STATE/ZIP/COUNTRY_____________________________________________
TELEPHONE NUMBER _____________ _______ E-MAIL ADDRESS
___________
_
VISA __ VISA DEBIT CARD __ MC __ MC DEBIT CARD __ AMEX __ DISCOVER __ CHECK __ MO __ (please check one)
CREDIT
CARD ORDERS (please complete)
NAME AS SHOWN ON CREDIT CARD____________________________________
CREDIT CARD
NUMBER________________________________________________
EXPIRATION DATE ______________
SIGNATURE__________________________
| STOCK # | QUANTITY | DESCRIPTION | PRICE | TOTAL |
| SUBTOTAL (MINIMUM ORDER AMOUNT IS $100.00) | |
| GROUND SHIPPING -- ENTER $22.00 (CONTINENTAL USA ONLY) | |
| SECOND DAY SHIPPING -- ENTER $32.00 (HAWAII & ALASKA - ENTER $42.00) | |
| OVERNIGHT SHIPPING -- ENTER $42.00 (NOT AVAILABLE HAWAII & ALASKA) | |
| PRIORITY OVERNIGHT SHIPPING -- ENTER $52.00 (AM DELIVERY) | |
| SATURDAY PRIORITY OVERNIGHT SHIPPING -- ENTER $62.00 (SATURDAY AM DELIVERY) | |
| INTERNATIONAL SHIPPING (ENTER 20% OF SUBTOTAL-MINIMUM $69.00) | |
| SUBTOTAL | |
| SALES TAX (WASHINGTON STATE ONLY - ENTER 8.6%) | |
| TOTAL AMOUNT DUE WITH ORDER |