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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:________________________________ |
Acroprint Model BP125-6NR4 (prints month,
date, regular hours and minutes)..Qty Ordered___Price
Each $425.00 Total_________
Acroprint Model BP125-6AR3 (prints day, regular
hours and minutes).................Qty Ordered___Price
Each $425.00 Total _________
Acroprint Model BP125-6RR4 (prints month,
date, military hours and hundreths).Qty Ordered___Price
Each $425.00 Total _______
Extra Ribbon........................Quantity Ordered_______Price Each $9.00 Total ___________
Shipping costs... $12.50 one clock ... $25.00 two clocks ... $37.50 three clocks ... Shipping Total ________
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:_________________
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