Amano Pix 10, Pix 15, Pix 21
Print and Fax to: 215.674.9338
or mail to:
Pitrone & Associates
9 Park Avenue
P O Box 711
Hatboro, PA 19040
Any questions call 215.956.9797 8:30AM to 4:30PM EST
Monday - Friday
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Name:__________________________________ Company:_______________________________ Address:________________________________ Address:________________________________ City:________________________State:______ Country:___________ZipCode:_____________ Phone Number:__________________________ Fax Number:____________________________ E-Mail:________________________________ |
Name:__________________________________ Company:_______________________________ Address:________________________________ Address:________________________________ City:________________________State:______ Country:___________ZipCode:_____________ Phone Number:__________________________ Fax Number:____________________________ E-Mail:________________________________ |
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Ribbons for Amano Pix 10, 15, 21,
(6 to 9 ribbons) Quantity Ordered_____Price Each $10.00 Total
__________ Ribbons for Amano Pix 10, 15, 21,
(10 to 35 ribbons) Quantity Ordered_____Price Each $9.00
Total _________ Ribbons for Amano Pix 10, 15, 21, (36
or more ribbons) Quantity Ordered_____Price Each $8.50 Total ________ Amano Pix 10, 15, 21, KEYS ..................................
Quantity Ordered_____Price Each $5.00 Total ________ Shipping (flat rate continental U.S.A shipments)______________________________________$7.50 PA State 6% Sales Tax (PA SHIPMENTS ONLY) ____________________________Total_____________ Charge to my: [MasterCard]____[Visa]____[Discover-Novus]____[American Express]______ Cardholder Name:_________________________________________________ Card Number:_____________________________________________________ Exp Date:_________________ Signature:________________________________________________________ Date:_________________ |
