SULTANTRONICS ORDER FORM

FOR 706/7000 RELAY SAVER

Print out this blank form and fill it out. You can pay by check or money order and mail this completed form along with payment to Sultantronics P.O. Box 1707 Sultan, WA. 98294.

Name_________________________________________________

Address_______________________________________________

City, State, Zip___________________________________________

Daytime Phone number___________________________________

(only used for emailing confirmation of order and date of shipping)

Email Address___________________________________________

MODEL                                 QTY

_________________________________________________

_________________________________________________

_________________________________________________

                      TOTAL QTY_______________

TOTAL PRICE (TOTAL QTY x $32.00)______________

Add 13 pin acc plug @ $10.00 each_____________

SALES TAX  8.5%(WA residents only)____________

SHIPPING/HANDLING (USA only ,up to 1 lb) $6.30

                    GRAND TOTAL_______________