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The order form is a method for the readers to order directly off the web. Ask the customers to print out this form and either mail it or fax it in to your office.

Your Company Order Form

The item you would like to order is a:

____________________________________________

The item number of the product (see catalog)

___________________________________

Method of Payment:

Cash ____ Check _____ Credit Card_______

Please write your personal information here:

Name: _____________________________________

Address: ___________________________________

___________________________________________

Phone: ______________________

Would you like us to send your purchase here?

Yes No (please put address below)

Name: _____________________________________

Address: ___________________________________

___________________________________________

Phone: ______________________

Please print out and fax this form to: (area code) phone-number