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Please print and FAX this order form to 801.504.0038
Name _________________________________________________________________________
Shipping Address _______________________________________________________________
City/town ______________________________________________________________________
State/Province _______________________________Zip/Postal code ______________________
Country _______________________________________________________________________
E-mail address _________________________________________________________________
Telephone_____________________________________________________________________
Your FAX number________________________________________________________________
I would like to order the following:
ITEM QUANTITY CODE PRICE
____________________________________ ______________ ___________ __________
____________________________________ ______________ ___________ __________
____________________________________ ______________ ___________ __________
____________________________________ ______________ ___________ __________
____________________________________ ______________ ___________ __________
____________________________________ ______________ ___________ __________
Subtotal $________________________
Shipping and Handling (UPS Standard Delivery) $ 5.00 per order
(Call for overnight delivery prices)
Total Enclosed (U.S. Dollars) $________________________
Payment:
Credit Card
Name on Card_______________________ Expiration Date______________________
Type of Credit Card_______________________________________________________
Card Number____________________________________________________________
FINE PRINT: Orders are processed immediately and cannot be modified or cancelled after they are submitted.
Products ordered may not be returned for a refund or exchanged. If you provide us with your e-mail address,
you will receive automatic confirmation of your order by e-mail within three business days. Your order will be
shipped by US Postal Service mail to most United States addresses. International Orders are shipped by UPS
Standard unless overnight delivery is specified. Please contact us if your order seems to be delayed. Ordering
any product constitutes your understanding and acceptance of these terms.
Name _________________________________________________________________________
Shipping Address _______________________________________________________________
City/town ______________________________________________________________________
State/Province _______________________________Zip/Postal code ______________________
Country _______________________________________________________________________
E-mail address _________________________________________________________________
Telephone_____________________________________________________________________
Your FAX number________________________________________________________________
I would like to order the following:
ITEM QUANTITY CODE PRICE
____________________________________ ______________ ___________ __________
____________________________________ ______________ ___________ __________
____________________________________ ______________ ___________ __________
____________________________________ ______________ ___________ __________
____________________________________ ______________ ___________ __________
____________________________________ ______________ ___________ __________
Subtotal $________________________
Shipping and Handling (UPS Standard Delivery) $ 5.00 per order
(Call for overnight delivery prices)
Total Enclosed (U.S. Dollars) $________________________
Payment:
Credit Card
Name on Card_______________________ Expiration Date______________________
Type of Credit Card_______________________________________________________
Card Number____________________________________________________________
FINE PRINT: Orders are processed immediately and cannot be modified or cancelled after they are submitted.
Products ordered may not be returned for a refund or exchanged. If you provide us with your e-mail address,
you will receive automatic confirmation of your order by e-mail within three business days. Your order will be
shipped by US Postal Service mail to most United States addresses. International Orders are shipped by UPS
Standard unless overnight delivery is specified. Please contact us if your order seems to be delayed. Ordering
any product constitutes your understanding and acceptance of these terms.
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