Blacet Research Order FormBlacet Research 15210 Orchard Rd Guerneville CA 95446707-869-9164 john@blacet.com http://www.blacet.com *********************************************** Ship to: Name: ___________________________________________ _________________________________________________ Address: _________________________________________ City, State, Zip: ____________________________________ _________________________________________________ Phone Number: ____________________________________ E-mail: ___________________________________________ ************************************************* Credit Card Info: Billing Address: Check here if same as above___ Name on card:____________________________________________ Address:__________________________________________ City, State, Zip:____________________________________ Card Type: MC___ VISA___ Number:_________________________ Expiration Date:___________________ ******************************************************************* Quantity Part Number Description Knob Color (blue, grey, red, orange, yellow) Price _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Total: __________ 7.25% (x .0725) CA Sales Tax (CA shipments only): __________ Shipping (US: $4 for the first item or module, $2 for
each additional module, add $4 for each PS500)
Grand Total: __________
We accept MC, VISA, MO, checks, Pay Pal, cash via Registered Mail. Call or e-mail for other payment options such as bank to bank transfer. |
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