SULTANTRONICS ORDER FORM

FOR SURPLUS ELECTRONICS SALE

Print out this blank form and fill it out. You can pay by check or money order or charge it with Visa or Mastercard and mail this completed form along with payment to Sultantronics P.O. Box 1707 Sultan, WA. 98294 or (for charge card orders only) FAX the completed form to 360-793-9513.

Name_________________________________________________

Address_______________________________________________

City, State, Zip___________________________________________

Daytime Phone number___________________________________

Email Address___________________________________________

7800 surplus PCB's 				 QTY _____

TOTAL PRICE                     $8.00 x QTY _____

SALES TAX     8.5%(WA residents only)____________

SHIPPING/HANDLING    (Continental USA only)$12.55

              GRAND TOTAL________________________

Payment: ___Check(#______)/money order __VISA __Mastercard

Card Number______________________________________

Expiration date_____________________________________