| Order Form |
You can also use this form to place your order without using our online shopping cart.
Simply fill up this form, print and fax it over to .
We will contact you within 24 hours after we receive this form or you can call us at . |
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| Contact Information |
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| Full Name: |
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| Telephone Number: |
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| E-Mail Address: |
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| Address: |
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| City, State and Zip: |
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Shipping Information (leave blank if same as above) |
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| Full Name: |
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| Address: |
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| City, State and Zip: |
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| Order Information |
| Quantity |
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Product Model/Description |
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Price |
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Total |
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Shipping Method: USPS 2-3 Days Priority Mail USPS Express UPS |
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| Sub-Total: |
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| CA Sales Tax (8.75%): |
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| Shipping Rate: |
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| Shipping Insurance: |
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| Total Due: |
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| Name on Credit Card: |
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| Credit Card Type: |
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| Credit Card Number: |
Expiration Date:
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| Comments |
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| Prices subject to change without notice. |
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