MRR PCB
Order Form
Please fill out this form, print and mail to:
MRR PCB
C\O Jerry F. Barnes
5138 Atchinson Drive SE
Olympia, WA 98513-4529 USA
Phone:
360 456-0572
Name
Address
City
State
Zip Code
Country
Phone Number
E-mail
Part Number
Description
Qty.
Unit
Price
Extended
Price
Shipping within the U.S.A.:
$6.00 on orders Under $50.00;
Shipping within the
U.S.A.:
$7.00 on
U.S.A
orders over $50.00
Shipping to Canada:
Add $8.00
Shipping to all other countries:
Add $9.00
Shipping (See left)
Total Enclosed
Payment Method:
Check
Money Order
Check or Money Order Number:
Payable to Jerry F. Barnes
Authorized Signature:
BACK
Date in: __________ Date out: __________ Order number: ____________
© Jerry F. Barnes 19 March 1997, All rights Reserved.