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Your Daytime Phone No. (______)______________________
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 Ship To:

First Name:

 

Last Name:

 

Address:

 

Address:

 

City:

 

State:

 

Zip Code:

 

Country:

 

 Item(s) To Order:

Qty

Name of Item

Model #

Price Each

Extended Price

 

 

     
         
         
 

                 Enter Lot # if applicable (sale items)

     

Line A

Total Price of Items Above  

Line B

Delivery in Illinois, add 6.25%  

Line C

Contiguous USA Shipping/Handling Charges
via UPS gnd = $30.00 per each large item (excluding Model Stands, Racks and Drawing Table
s)

Parts order UPS gnd = $7.95 per item

 

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Total Amount

 
Method Of Payment (Charge Card Information./ US funds only.)

Charge order to my (circle one):             VISA          MASTER CARD    American Exp.

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Signature:                                                                           Today's Date:

                                         Thank You!