Page 19 of Far Circuits by Far Circuits

19 19 FAR CIRCUITS ORDERING FORM 18N640 FIELD COURT, DUNDEE, ILLINOIS 60118 SHIP TO:___________________________________ Date:___________________ ___________________________________________ (NOTE: SHIP TO NAME ADDRESS MUST BE THE SAME AS CREDIT CARD) ____________________________________________ (PLEASE INCLUDE COMPLETE ADDRESS OR INCLUDE A RETURN ADDRESS LABEL)(33003) Zip or Postal Code_____________________________ QTY DESCRIPTION MAGAZINE, MONTH, YEAR, ARTICLE, TITLE ) AMOUNT 1 _____ _________________________________________________________________ $________ 2 _____ _________________________________________________________________ $________ 3 _____ _________________________________________________________________ $________ 4 _____ _________________________________________________________________ $________ 5 _____ _________________________________________________________________ $________ 6 _____ _________________________________________________________________ $________ 7 _____ Total Number of Boards .....................................................SUBTOTAL $________ US SHIPPING: 1 st CLASS MAIL $2.00 PER 4 BOARDS, PRIORITY MAIL $5.00, EXPRESS MAIL $20.00, 2 nd DAY FED X 18.00 $________ CANADA SHIPPING $2.00 PER 4 BOARDS. INTERNATIONAL (Excluding CANADA) $7.00 $1.00 PER EACH BOARD) $________ $3.00 CREDIT CARD SERVICE CHARGE (CREDIT CARD ORDERS ONLY Illinois sales tax ILLINOIS RESIDENTS ADD 6.5%) ARTICLES $1.50 EACH $________ $________ $________ TOTAL$________ Check number___________ Cash__________CREDIT CARD___________ Credit Card Company_______________( NOTE:Visa or Master Card ONLY) Credit Card #______________________________________Expir. Date____________ Home Phone Number: ___________________________________________ e-mail address__________________________________________________ Signature: Ham Call_____________________ Mail, or Fax Orders to 847-836-9148 SEND THE ORDERING FORM AS .pdf FILE BY THE INTERNET FOR MAXIMUM SECURITY.

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