MedExcel, Incorporated |
Order Form:
DATE:______ /______ / ______ |
| To: | Ship To: |
Product / Description |
Quantity #Units |
Extended Price |
Power Paw @ $19.95 ea |
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| ------------------------------------------------ | -------------------------------- | ------------------------------------- |
SHIPPING & HANDLING |
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SALES TAX |
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TOTAL DUE |
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[Shipping & Handling: $4.95 = 1- 2 units, $9.00 for 3-4, 5 or more = 12.5% of total of order]
| Name (as on Credit Card or Check:
Tel # to Contact You if needed: ( ) ______ - _________ x _________
|
| Credit Card Information: Visa Mastercard |
| Card Number: |
| Expiration Date: |
| Authz'n # (Internal Use Only) |
Make all checks payable to: MedExcel Inc.-
If you have any questions concerning this invoice, call: 512-418-9670
E Commerce not available yet, but you may print out this form and fax to: (512) 328 - 7324
THANK YOU FOR YOUR BUSINESS!
