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OCR: Semplex Order Form 24 Hour ordering (After hours answering service) 1-800-488-5444 To Fax your order (612) 522-0579 Item No. Qty Description Price $3 ORDER CHARGE Only on orders under $5 SHIPPING No charge except for except for items marked FOB SALES TAX (MN residents add 6.5% on non-food items) I have catalog # TOTAL PLEASE SEND MY ORDER TO: (If you have return address stickers, please enclose a few with your order so we may use them on your shipping label.) Name Phone ( Street Date City State Zip Check Enclosed - make check payable to Semplex Visa Master Card $10 minimum credit card order please. Card Number Expiration Date Semplex 4159 Thomas Avenue N, P.O. Box 11476V . Minneapolis, Minnesota 55411 · (612) 522-0500