Pitrone & Associates Fax Order Form

Timeclocking.com

Amano MJR7000 Order Form

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 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:________________________________

Amano MJR7000 timeclock(s)..........Quantity Ordered______Price Each $849.00 Total________

Amano timecards #000-099 2000/Box....Boxes Ordered ______Price Each $80.00 Total ________

Shipping (flat rate continental U.S.A shipments) (clock only)______$15.00

Shipping (flat rate continental U.S.A shipments) (clock and cards)_$20.00

Shipping (flat rate continental U.S.A shipments)................... (either $15.00 or $20.00)__________

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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