ADCO
Hearing Products, Inc. You may print this ORDER
FORM to place your prepaid order by mail or fax
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| ORDERED BY: Note - UPS does not deliver to P.O. Box addresses | ||
| Your Name: | ||
| Company Name: | ||
| Address: | ||
| City: | State/Prov.: | |
| Zip Code: | Country: | |
| Phone with Area Code: | ||
| Fax with Area Code: | E-Mail: | |
| SHIPPED TO: Complete only if address is different than ORDERED BY shown above | ||
| Your Name: | ||
| Company Name: | ||
| Address: | ||
| City: | State/Prov.: | |
| Zip Code: | Country: | |
| Phone with Area Code: | ||
| PAYMENT BY: | ||
| - - - Expiration Date: Mo. Yr. | ||
| Type name exactly as it appears on credit card: | ||
| Check Enclosed - Please re-type amount: | ||
| Qty | Item No. | Item Description | Color/Size | Price Each | Total Price | ||||||||||||||||||||||||||
| Subtotal | |||||||||||||||||||||||||||||||
| CO Residents - Add 6.8% Sales Tax | |||||||||||||||||||||||||||||||
| Shipping & Handling - See Chart Below | |||||||||||||||||||||||||||||||
TOTAL
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ADCO Hearing Products, Inc.5661 South Curtice Street • Littleton, Colorado
80120
(800) 726-0851 • (303) 794-3928 • (303) 794-3704 FAX
sales@adcopro.net
(800) 726-0851 • (303) 794-3928 • (303) 794-3704 FAX
sales@adcopro.net