Printable Order Form For Elements, Molecules
and Mixtures Spectrum Viewers!
Print this form immediately to use in mail order or fax orders,

for international or differing quantities orders.

Name: ____________________________________________________________

Address: ______________________________________________________

              ______________________________________________________

City: ____________________State: _________Postal Code/Zip _____________

COUNTRY: ________________________

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

 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

$225.00 

_______________

Lighting Spectrum Viewer - 40 Viewer Cards

____ x

$285.00 

_______________

 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

$225.00 

_______________

 Elements  Spectrum Viewer - 40 Viewer Cards

____ x

$285.00 

_______________

Total

Sales

 

= $ _____________

 

 

 

 

Shipping Charges (see table to the right):

 

 

__We will do this!_



(  ) Mailing a Check?  Make check payable to Hermograph Press, at 2135 Interstate Drive #130, Opelika, AL  36801 USA, 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: Ranges from $5.95 to$10.00, depending on amounts.

Canadian Orders, TBD
Europe etc, TBD

 

CREDIT CARD INFORMATION

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

Name on the Card: ______________________________________________________

Card Number: _____________ _______________ _____________ _____________

Expiration Date: _____ / _______   Security Code: ____________

Signature: ___________________________________________

 

Your email address (that is associated with this card, if different from above): _____________________

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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