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Fax/Mail Order Form

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