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  1.  
  2.                                          Order and Invoice
  3. Syncom, Inc.
  4. P.O. Box 1592
  5. Morristown, New Jersey  07960-1592
  6.  
  7.  
  8. Ship to:
  9. Name:           _______________________________________________________
  10. Company         _______________________________________________________
  11. Department      _______________________________________________________
  12. Address:        _______________________________________________________
  13. City, State Zip _______________________________________________________
  14. Phone:          _____________________________
  15.  
  16.  
  17. Please Enter the following order:
  18.  
  19. Quantity 
  20. Ordered    Description                                 Price Ea.        Ext
  21.  
  22. _______    LED Display Custom Control for Visual Basic  $19.00*   $________.__
  23.                       New Jersey & New York residents 
  24.                             add applicable sales tax.             $________.__
  25.                                   Shipping & Handling                    $3.00
  26.  
  27.                                                  Total:           $___________
  28.  
  29. * International Orders add $5.00
  30. Please make checks and money orders Payable to: Syncom, Inc.
  31.  
  32.  
  33. Credit Card Information:
  34.  
  35. /__/ AmEx     /__/ Visa    /__/ MasterCard
  36. Credit Card Number:     _________________________________________
  37. Exp. Date:              ______ / _____
  38. Signature:              _________________________________________
  39.  
  40.  
  41. Mail this order to:
  42. Syncom, Inc.
  43. P.O. Box 1592
  44. Morristown, New Jersey  07960-1592
  45. or fax your order to 1-201-267-6605
  46.  
  47.