Specifications

ORDER FORM
QTY ITEM NO. NAME OF PRODUCT EACH TOTAL
SHIPPING & HANDLING
ADDITIONAL SHIPPING & HANDLING - As listed per item
NEW YORK RESIDENTS: Please
Add Applicable Tax on Taxable items
TOTAL AMOUNT
2005 1st Edition
ORDER NUMBER:_________________________ ACCOUNT NUMBER:__________________________ FOR OFFICE USE
ORDERED _________________________________________________DATE:_____________________
FIRST NAME MIDDLE INITIAL LAST NAME
_________________________________________________________________________________________________________
ADDRESS
_________________________________________________________________________________________________________
CITY STATE ZIP CODE
_________________________________________________________________________________________________________
E-MAIL DAYTIME TELEPHONE #
_________________________________________________________________________________________________________
O Check here if your address has changed since your last order.
BILLING INFORMATION
Please complete the following, if order is to be shipped to different address:
FIRST NAME MIDDLE INITIAL LAST NAME
_________________________________________________________________________________________________________
ADDRESS
_________________________________________________________________________________________________________
CITY STATE ZIP CODE
_________________________________________________________________________________________________________
E-MAIL DAYTIME TELEPHONE #
_________________________________________________________________________________________________________
SHIPPING INFORMATION
You can charge my order to my:
O Discover O Visa
O Master Card O American Express
ACCOUNT # _________-_________-_________-_________
EXPIRATION DATE _____/_____/_____
x_______________________________________
AUTHORIZED SIGNATURE
DATE _____/_____/_____ PHONE #_______________
ORDER IS VALID ONLY WITH AUTHORIZED
SIGNATURE AND PHONE NUMBER
PAYMENT INFORMATION
Shipping charges are not refundable. Additional shipping charges on
items where indicated. Shipping to Alaska, Hawaii, Puerto Rico & V.
Islands & Internationally require additional charges that will be added
to your invoice.
Sometimes we may be out of stock, please check if you would
like us to:
O Hold order if product(s) is temporarily out of stock
O Refund money immediately
O Send Catalog
O Send more order forms
$10-24.99...add $ 5.35
$25-49.99..........$ 6.25
$50-99.99..........$ 8.25
$100-199.99......$ 11.25
$200-299.99......$ 12.00
$300-499.99......$12.50
$500-999.99......$15.45
$1000-2000.......$17.45
$2001+..add $10.00 for
each additional $1000
US CONTINENTAL GROUND
SHIPPING & HANDLING CHARGES
If your order totals
THANK YOU FOR YOUR ORDER
42 Executive Blvd.,
Farmingdale,NY 11735-0813
To Order: 1-800-522-6294
For Info: 1-631-752-0521 TTY: 1-631-752-0738
Fax: [phone] Email: [e-mail]
MINIMUM ORDER $10.00
IMPORTANT: If you are claiming tax exemption, please
provide a copy of your Exemption Form or Resale Certificate.
Additional charges indicated when applicable