PRINT FORM( fill out)
Then : Fax or mail to:
Web Page
Fouraker Electronics
ORDER FORM
572-D Appleyard Dr. Tallahassee, Fl 32304
Phone 800-635-0420
Fax 850-574-6385
SOLD TO:
SHIP TO: (if different)
Name _____________________________ ______________________________
Company __________________________ ______________________________
Address __________________________ ______________________________
City/St/Zip ______________________ ______________________________
Phone ( ____ ) ___________________ Date of order ________________
Email address: ___________________________________________________
Special shipping instructions: ___________________________________
Other: ___________________________________________________________
Qty Stock #
Description
Price
Amount
_____ ________ _______________________ ________ _________________
_____ ________ _______________________ ________ _________________
_____ ________ _______________________ ________ _________________
_____ ________ _______________________ ________ _________________
_____ ________ _______________________ ________ _________________
_____ ________ _______________________ ________ _________________
_____ ________ _______________________ ________ _________________
_____ ________ _______________________ ________ _________________
_____ ________ _______________________ ________ _________________
VISA, MasterCard, Discover or Sub Total _________________
The American Express Card
C/C Name ______________________ 7.5% Fl Sales Tax _________________
C/C # ___________________________ (Florida residents only)
Card exp date _________________
S&H (leave blank) _________________
Signature _____________________ TOTAL (blank) _________________
( You will receive confirmation via e-mail
with all amounts before order is processed )