Print out form below, add information .... mail or fax
617 Congress Park Drive Dayton Oh 45459
Tel. 937-231-8822 Fax. 937-434-0840
Name:
Street Address: nbsp;
Suite# / Apt# or Attn:
City / State / Zip:
Telephone #: Fax #:
E-Mail Address: for notification of shipping and UPS tracking #)
Qty Item # Desc
Qty Item # Desc Price Ea. Amount
Qty Item # Desc Price Ea. Amount
Qty Item # Desc Price Ea. Amount
Qty Item # Desc Price Ea. Amount
Merchandise Total:$
Sales Tax for Ohio customers-Add 7 % to merchandise total:$
Sales Tax for OHIO CUSTOMERS -
Add 7. % to Merchandise total: $
Shipping UPS Ground: Total with
shipping & taxes $
Credit Card: MasterCard VISA Discover American
Express Check
(Personal and Company checks will take several extra days to clear
before order ships)
Credit Card #: Expiration:
(Mo/Yr)
(If name on credit card and/or billing address is different
than ship to, please insert that information below)
Comments / Additional Instructions:
We accept:
/ secure payment via PayPal Payment Services.
All items are subject to Manufacturer's availability and production.
We reserve the right to refuse any order(s) placed for any reason. Prices
are subject to change without notification.