Print this form and fax to 831-536-1098 (phone 831-726-7114)

Customer Information
Name as it appears on credit card

Your name if different than above

Shipping address

City State Zip

Phone Fax E-mail




Method of Payment Visa or Mastercard #
Expiration Date **/**/** or **/** as shown on card  




Unit Price

Extended Total































K Rubber checks are subject to $40 recycling fee.
J Returns require an authorization number and are subject to a 15%
re-stocking fee.
L 1 1/2% added each month to past due accounts.
J Please submit resale card for tax exempt sales.

Sub Total


Sales Tax






1999 Controlled Access Security Equipment, All rights reserved