Fax Form

Fax to: (408) 739-2420 or Mail to: Palo Alto, Sunnyvale, San José, or Fremont

Ordered by:
Name
Address
Phone

Ship to:
Name
Address
Phone

Method of Payment:

Discover _____

AmEx _____

Visa _____

MasterCard _____

Quantity    Item #      Name                         Cost Each   Total Amount











SubTotal                                                                _______________

Shipping                                                                _______________

Sales tax (CA residents add 7.5%)                                       _______________

Grand Total                                                             _______________