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  

Quantity

Unit

Description

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

 

Shipping

 

Total

 

1999 Controlled Access Security Equipment, All rights reserved