ORDERED BY: SHIP TO:
(Please print) (Please print)
________________________________________ ___________________________________________
Name
Name
________________________________________ ___________________________________________
Address Address (P.O. Box, if applicable, & Street Address)
________________________________________
___________________________________________
City, State,
Zip
City, State, Zip
(______)_________________________________
Daytime phone number Date: __________________
School Name: ____________________________
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IP# |
QUANTITY |
ITEM NAME |
PRICE EACH |
PRICE TOTAL |
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[If more room is needed, please use additional page(s)]
Order Total $ ____________
Shipping/Handling* ____________
Sales tax **
___________
*Add 10% for shipping and handling
Canadian & foreign orders, see Ordering Information above.
TOTAL ENCLOSED $ _____________
** Michigan residents, add 6 % on order total.
If tax exempt, please attach proof of tax exemption or add sales tax.
Payment:
q A check payable to Makitso, Inc. THANK YOU FOR YOUR ORDER!
q Official Purchase Order #__________________
q
Credit Card payment
q Visa
q MasterCard
Credit Card #__________________________________
Expiration Date: _______________________________
Print cardholder name: __________________________
Signature: ____________________________________
(Required for processing)
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