| Name | |
| Company | |
| Address | |
|
Shipping Address (if different from above) |
|
| Phone Number | |
| Email address | |
| Computer Manufacturer/Model |
|
|
|
Description
|
Quantity
|
Unit Price
|
Amount
|
| PC Shade - Medium (14" screens, not widescreen format) |
______
|
$29.95
|
______
|
| PC Shade - Large (15" screens, not widescreen format) |
______
|
$29.95
|
______
|
| PC Shade - Large (15" widescreen format) |
______
|
$31.95
|
______
|
| PC Shade - Extra Large (17" widescreen format) |
______
|
$34.95
|
______
|
| Shipping (1 unit) |
$5.95
|
______
|
|
| Shipping
(additional
units) |
______
|
$1.00
|
______
|
| SUBTOTAL |
______
|
||
| Sales Tax - 8.25% (CA residents only) |
______
|
||
| TOTAL |
______
|
|
|
| Payment Type (circle one) |
Check
|
Credit Card
|
Please make checks payable to PC Shade.
Credit Card Number:____________________________________
Expiration Date:____________
Credit Card Holder's Name:____________________________________
Credit Card Billing Address:____________________________________