Company
Name
Address
City
Zip/Postal Code
Day Time Phone Number
Fax Number
Circle the card
you have
you have
Visa
Master Card
Qty. |
Part# |
Description: |
Price: |
Totals: |
|
| 1) | 72186-1 | single set | $ 29.95 ea. |
$ |
|
| single set shipping charge | 8.00 ea. | ||||
| 2) | 72186-6 | case 6 sets | $ 107.82 ea. |
$ |
|
| case shipping charge | 11.00 ea. | ||||
| 3) | 72186-24 | 24 Bulk sets no packaging | $ 382.80 ea. |
$ |
|
| 24 bulk shipping charge | 23.00 ea. | ||||
| 4) | 72186-36 | 36 Bulk sets no packaging | $ 502.20 ea. |
$ |
|
| 36 bulk shipping charge | 29.00 ea. | ||||
| 5) | 72186-50 | 50 Bulk sets no packaging | $650.00 ea. | $ | |
| 50 Bulk shipping charge | 32.50 ea. | ||||
| 6) | 72186-100 | 100 Bulk sets no packaging | $1200.00 ea. | $ | |
| 100 Bulk shipping charge | 60.00 ea. | ||||
| Shipping Charges: Covers shipping, handling, packaging, tracking and insurance where applicable. | Subtotal: | $ _____ |
|||
| For International orders, please e-mail us for a quote on shipping charges. |
S&H: | $ _____ |
|||
| Sales Tax - California residents add 7.75% | $ _____ |
||||
| TOTAL: | $ _____ |
||||
By signing and faxing this form to Back to Basics Innovative Design I authorize them to debit my credit card for the items ordered with this form charges well also include s&h along with California sales tax if required.
Signature
Date