Order Form

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Date: ____________________ Purchase Order # (optional): ____________________

Bill to:

Name ___________________________________ School ___________________________________

Street ___________________________________ City ______________________________ State _______ Zip ________

Daytime Phone (_____) ____________________

Ship to:

Name ___________________________________ School ___________________________________

Street ___________________________________ City ______________________________ State _______ Zip ________

Daytime Phone (_____) ____________________

Title of Item	Code	Qty.	Cost	Total
1.	1.	1.	1.	1.
2.	2.	2.	2.	2.
3.	3.	3.	3.	3.
4.	4.	4.	4.	4.
5.	5.	5.	5.	5.

Subtotal Total: _________________________

Sales Tax (if applicable, 7.25% for Dutchess County): _________________________

Shipping and Handling (see below): _________________________

Total Amount: _________________________

Shipping and Handling Charges:

$6.00 for all order less than or equal to $100 / 10% of total for orders over $100

Send check, money order or school invoice to:

K. H. Computer Concepts

7 Lewis Road

Wappingers Falls, NY 12590

Phone or Fax: (845) 485-7697 / E-mail: keith.humphrey@worldnet.att.net / Return to Main Menu