Order Form

 (Note: This is a tab-through form, do not use "Enter" key)
Bill to:
Name:
Company:
Street Address:
City:
State:
Zip:
Phone:
Fax:
e-mail:
Ship to:(if different from "bill to")
Name:
Company:
Street Address:
City:
State:
Zip:

Enter Coupon Code:
Payment Method:
Me
Purchase Order

(We ship open account to firms rated in D&B). On California orders we will add appropriate sales tax. If you wish this charged to your credit card, we accept MasterCard, Visa and American Express.
Credit Card:
 MasterCard    Visa         Amex
Name on Card:
Card Number:
Expiration Date:
Enter the 3-digit number added to acct. on back of Visa or MasterCard —
       4-digits on front, bottom right of Amex.

If you wish, you may print out this form and fax it to:
805/966-7659
Please ship:
Qty.
Model
Product Name
Price


Orders will be filled at prices in effect at time order is placed.

California firms subject to Sales Tax.

We will confirm pricing, shipping, etc. on your order the next business day by
    fax or e-mail. If you wish to phone in your order or to have questions answered,
                                            Call:  800/922-0977
                                            Monday thru Friday 8 am — 4 pm — PST