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Your Name: _____________________________________________________________
Your Company Name: _____________________________________________________
Billing Address:___________________________________________________________
___________________________________________________________
Phone: _________________________ Fax: ____________________________________
E-Mail: _________________________________________________________________
| Order: |
Amount Desired
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|
l
Flash Target (Model
#DK8 MKll)
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-
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$159.95 each*
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$ Total
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|
Subtotal
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$
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| + Colorado Residents Only Add Sales Tax of 5% | $ | ||
|
Subtotal (without shipping charges)
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$ | ||
| Payment: Order
by credit card or money order only. No COD orders accepted. Payment will be processed on all orders at time of ordering. |
| Cashiers Check or Money Order |
| Visa/Mastercard Account Number: _______ - _______ - _______ - _______ |
| Expiration Date: _______ - _______ |
| Name on Credit Card: ____________________________ |
Signature Required if Using Credit Card: _______________________________________________ |
Shipping Address: (if other than listed above) |
| Name: _____________________________________________________ |
Shipping Address:________________________________________________________ |
_______________________________________________________________________ |