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| Bill To: | Ship To: (if different than bill to) |
| Name:_____________________________________ | __________________________________________ |
| Company Name:_____________________________ | __________________________________________ |
| Address:___________________________________ | __________________________________________ |
| __________________________________________ | __________________________________________ |
| City, State, Zip:______________________________ | __________________________________________ |
| Phone:______________________ | Fax:_________________________ | email:________________________ |
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Part No. | Description |
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Extended
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Subtotal
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State tax (5% if in Iowa only)
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Shipping (see matrix)
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Total *
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Click on destination to see appropriate shipping matrix |
| Ship in U.S.A. by: | |||
| UPS/FedEx Ground | UPS/FedEx (2 day) | ||
| UPS/FedEx (next day) | Federal Express (acct no.)___________________________ | ||
| Ship to Canada by: | |||
| Global Priority Mail | UPS International | ||
| Ship to Europe by: | |||
| Global Priority Mail | UPS International | ||
| Ship to South America by: | |||
| Global Priority Mail | UPS International | ||
| Ship to Australia by: | |||
| Global Priority Mail | UPS International | ||
| Ship to Africa by: | |||
| Global Priority Mail | UPS International | ||
| Ship to Asia by: | |||
| Global Priority Mail | UPS International | ||
| Method of payment: (please check one) | |||
| American Express | MasterCard | ||
| Discover | Visa | ||
| Personal or company check
(allow 3 weeks for processing) |
COD (certified or cashiers check only)xxxxxxxxxxxxxxxxxxxxxxxxx | ||
| Special Instructions: | _________________________________________________________________ | ||
| ___________________________________________________________________________________ | |||
| ___________________________________________________________________________________ | |||
| Credit card #: | ________________________________________________ | Exp. date: | __________ |
| Name on card: | ________________________________________________ | ||
| Signature: | ________________________________________________ |
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