Pitrone & Associates Fax Order Form

Digital Smart Clocks Model #BSA Order Form

Print and Fax to: 215.674.9338

or mail to:

Pitrone & Associates

P O Box 711

Hatboro, PA 19040

Any questions call 215.956.9797 9:00AM to 4:30PM EST Monday - Friday

Billing Information

Name:__________________________________

Company:_______________________________

Address:________________________________

City:________________________State:______

Country:___________ZipCode:_____________

Phone Number:__________________________

Fax Number:____________________________

E-Mail:________________________________

Shipping Information

Name:__________________________________

Company:_______________________________

Address:________________________________

City:________________________State:______

Country:___________ZipCode:_____________

Phone Number:__________________________

Fax Number:____________________________

E-Mail:________________________________

Digital Smart Wall Clocks 4 digit clocks (hours and minutes)
Model BSA 41218 Digit size 1.8" 12 hour ..Quantity Ordered ______Price Each $142.00 Total_________
Model BSA 42418, Digit size 1.8" 24 hour...Quantity Ordered ______Price Each $142.00 Total_________

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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