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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:________________________________ |
Model BSA 41225, Digit size 2.5" 12 hour....Quantity
Ordered______Price Each $174.00 Total_________
Model BSA 42425, Digit size 2.5" 24 hour....Quantity
Ordered______Price Each $174.00 Total_________
Model BSA 41240, Digit size 4" 12 hour.....Quantity
Ordered_______Price Each $210.00 Total_________
Model BSA 42440, Digit size 4" 24 hour.....Quantity
Ordered_______Price Each $210.00 Total_________
Digital Smart Wall Clocks 6 digit
clocks (hours, minutes & seconds)
Model BSA 61225, Digit size 2.5" 12 hour....Quantity
Ordered_______Price Each $256.00 Total_________
Model BSA 62425, Digit size 2.5" 24 hour....Quantity
Ordered_______Price Each $256.00 Total_________
Model BSA 61240, Digit size 4" 12 hour.....Quantity
Ordered_______Price Each $319.00 Total_________
Model BSA 62440, Digit size 4" 24 hour.....Quantity
Ordered_______Price Each $319.00 Total_________
Shipping prices continental U.S.A
shipments... (1 clock....$9.00) (2 clocks ...$12.00)
(3 clocks ... $15.00) (4 clocks... $18.00) (5 clocks... $21.00)
Shipping ( continental U.S.A shipments)________________ Shipping Charge__________
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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