Printable Order Form For Elements, Molecules
and Mixtures Spectrum Viewers!
Print this form immediately to use in mail order or fax orders.
(or download this PDF file if the form doesn't print well for you.)
Name: ____________________________________________________________

Address: ______________________________________________________

              ______________________________________________________

City: ____________________State: _________Postal Code/Zip _____________

COUNTRY: ________________________

EMAIL: ______________________________________________

Telephone: ______________________________________________________

EMAIL: ______________________________________________

Fax Number (if you fax your order to us, we need this): _____________________________

Ship To:
 ( ) Same as billing address

 ( ) This Different Address Below:

Name: ______________________________________________________

Address: _______________________________________________

 _______________________________________________

City:____________________State:__________

Postal Code/Zip _________

COUNTRY: ________________________

ITEM
 Number
 Per Unit Cost
 Extension
 Elements Spectrum Viewer - 1 Viewer Card
 ____ x
 $9.50  _______________
Elements Spectrum Viewer - 10 Viewer Cards ____ x
 $85.00
 _______________
Elements Spectrum Viewer - 30 Viewer Cards ____ x
 $218.00
 _______________
Elements Spectrum Viewer - 40 Viewer Cards ____ x
 $285.00
 _______________
Lighting Spectrum Viewer - 1 Viewer Card
 ____ x  $9.50
 _______________
Lighting Spectrum Viewer - 10 Viewer Cards ____ x $85.00
 _______________
Lighting Spectrum Viewer - 30 Viewer Cards ____ x $218.00
 _______________
Lighting Spectrum Viewer - 40 Viewer Cards ____ x $285.00
 _______________
SUBTOTAL


Shipping Charges (see table to the right):



_______________

Total



= $ _____________


(  ) Mailing a Check?  Make check payable to Hermograph Press, at 3605 Sandy Plains Road, Suite 240-203H,  Marietta, GA 30066, or

(  ) postal mail with Credit Card information, form to the right-->

(  ) Or fax form to +1 404 393 7037 with the Credit Card information, form to the right-->

SHIPPING
US > $100, Shipping is FREE!
US < $100 orders: 1 Viewer $3.95, $10-pack $15
Canadian Orders, Add -TBD
Europe etc, Add TBD



CREDIT CARD INFORMATION

   Pay with:   ( ) American Express       ( ) MasterCard         ( ) Visa

Name on the Card: ______________________________________________________

Card Number: _____________ _______________ _____________ _____________

Expiration Date: _____ / _______   Security Code: ____________

Signature: ___________________________________________

Returns accepted for 30 days if in saleable condition.

Thank you for your Viewer order! Please allow 1 week for processing and shipping.

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