Complete 2014 Catalog

VII

CUSTOMER ORDER BLANK

PHONE: (800) 253-2954 USA

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(760) 255-1030 International

FAX:

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TELEPHONE NUMBER

NAME

DATE

MAILINGADDRESS

SHIPPINGADDRESS

ZIP

STATE

CITY

QUANTITY

DESCRIPTION OF ITEM

UNIT PRICE

TOTAL

SHIPPING

ORDER #

lbs.

oz.

TOTAL

PLEASE INDICATE MANNER OF PAYMENT BELOW

AMOUNT FOR SHIPPING/HANDLING CARESIDENTSADD 7.5% SALES TAX ADD $2.00 FEE ON ORDERS UNDER $20.00 TOTAL FOR GOODS

lbs .

oz.

CHECK ❒

VISA ❒

MASTER CARD ❒

DISCOVER ❒

AMEX ❒

TOTALWT. IN POUNDS

CARD #

EXPIRATION DATE

CARD HOLDER'S SIGNATURE

TOTALAMOUNT