To place an order print this form, complete, and email to service@e-shoq.com
Customer / Shipping Information (please print clearly)
Name:__________________________ Job Title:___________________________
Company:________________________ Address:__________________________
City:____________________________ State/Province:______________________
Zip/Postal Code:___________________ Country:___________________________
Phone:__________________________ Fax:______________________________
Email:____________________________
Order Information
| Product | Price (US dollars) | Shipping & Handling * | TOTAL | |
|
$399.00
|
$ | |||
| TOTAL | $ |
* $20 in USA / Canada for overnight delivery; $55 for Overseas delivery
Payment Information
___ Please issue me an invoice