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To order, please
print this form, complete the information, and fax it to 559-665-0388.
Name_________________________________________________________________
Address_______________________________________________________________
______________________________________________________________________
City_____________________________State____________Zip___________________
Phone Number____________________
Fax Number__________________________
Email_________________________________________________________________
Items Ordered
Item #
Description Quantity
Price Total
_________ _________________________
_______ ________ _________
_________ _________________________
_______ ________ _________
_________ _________________________
_______ ________ _________
_________ _________________________
_______ ________ _________
_________ _________________________
_______ ________ _________
Subtotal _________
Sales Tax (California residents
add 8.5%) _________
Shipping (CLICK
HERE) _________
Total _________
Payment Options:
___ Visa ___ Mastercard ___Discover ____Am
Exp
Credit Card Number
________________________
Expiration Date
________________________
Cardholder Name
________________________
Cardholder
Signature_______________________
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