To
place an order, print this form and mail it with credit card information
or money order to: BERDA CompuGraphix, 220 Holly Road, Chicora, PA 16025, USA. or fax it to (724) 445-5082.
Customer
Name: ___________________________
Business
Name: ____________________________
Address:
_________________________________
City:
_________________
State:
____
Zip:
_____
________________
Telephone
________________
Fax
Number
________________
E-Mail
Address
QUANTITY
DESCRIPTION
UNIT
PRICE
TOTAL
PRICE
Guard
Dog Sign Kit
6%
Sales Tax (PA Residents only):
Total:
Price
is $9.99 per kit plus $2.99 shipping. Additional kits will incur a small additional shipping charge.
PAYMENT
METHOD:
Visa/MC
Discover
_______________________
Card Number
____________
Expiration
Signature
___________________________________
Required
for Credit Card Purchases
Money
Order
Enclosed
LEGAL
NOTICE:
The
seller, BERDA CompuGraphix, assumes no liability, expressed or implied
from any action resulting from the use of this product. Buyer agrees
to save and hold harmless seller (BERDA CompuGraphix) from any damages
real or incidental, resulting from the use of this product.
By
checking this box, I agree to the conditions stated above.
Signature:
___________________________________
Customer
Signature Required to process order
