CycleStat® DC CounterOrder Form |
FAX credit card order to 1-360-681-6904 or mail with payment to ESC Products Corp., P.O. Box 520, Carlsborg, WA, USA 98324Home © 2001-2009 ESC Products Corporation
Name:
Address:
City:
State/Province: Zip/Postal Code:
Country: Telephone Number or Email:
Qty _____ CycleStat® MC-1-12V at $79.95/ea, total $____________
Qty _____ CycleStat® MC-1-24V at $84.95/ea, total $____________
Qty _____ CycleStat® MC-1R-12V at $99.95/ea, total $____________
Qty _____ CycleStat® MC-1R-24V at $104.95/ea, total $____________
Total for order: $______________
Washington residents: Wa State sales tax will be added to your order.
There is no charge for shipping by regular mail within the US and Canada. Charges for requested alternative shipping will be added to your order. See How to Order for other shipping methods or shipping to other countries. For alternative shipping, please specify here __________________
Method of Payment:
Credit Card Number Expiration Date: Name of cardholder (please print) Signature of cardholder: