3620-9A Whitehall Road
Anderson, SC 29626
Phone (864)226-6990; Fax (864)225-4565

Order by FAX

This form for use with orders from OUTSIDE the USA

Date:
P O #:
Phone No:
Country, City, Local
Email: For verification notice
Call Sign:
Company:
Ship to Name:
Address1:
Address2:
City, Country, Post Code:
Credit Card:
Exp Date: Mon, Yr:
Item Quantity Catalog No. Item Quantity Catalog No.
1 2
3 4
5 6
7 8
9 10
11 12

Enter any special note or request:

Order Subtotal $
Shipping and Handling (We will provide a firm S&H cost upon email request, including each item you wish to buy.)$
Grand Total $

(You may leave the totals blank and we will calculate them, including S&H)

Please FAX this completed form, including credit card information to (USA) 864.225.4565. Your order will be shipped as soon as possible.