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This form is to be used if you wish to fax or mail your order instead of online or phone ordering. Just use your browsers print button to print out the form. Note, we cannot ship to a PO box. SHIP TO: Name:_______________________________________ Address:____________________________________ City/State/Zip:_____________________________ Country:____________________________________ Phone:______________________________________ Product Description-------Price Ea.----Qty----Total ___________________________________________________ ___________________________________________________ ___________________________________________________ Subtotal -----------------------------------________ Shipping ----------------------------------________ UTAH Sales Tax 6.25% (UTAH residents only)________ Total --------------------------------------________ Payment Information: Payment:Amex___MC___Visa___Disc___Money Order___ Card #____________________ Expiration Date (month/year)____/____ Signature____________________ Fax/Mail to: kkontrols.com 516 N 200 W Cedar City, Utah 84721 Phone: 435-865-1313 Fax: 435-865-1333 |