MicroMac Technology Fax Order Form

MicroMac Technology's business hours are 8:30 am to 5:30 pm PST/PDST, Monday through Friday.

To Place a Fax Order:

1. Print out the Fax Order form.
2. Fill out the order form with the necessary shipping, product and billing information.
3. Fax your order to 949-362-5428.
4. MicroMac Technology will process your order

Send to:

Name__________________________________________

Street Address________________________________

City__________________________________________

State/Province________________________________

Zip/Postal Code_______________________________

Country_______________________________________

Telephone_____________________________________

Fax___________________________________________

Email_________________________________________

Product:

MicroMac Product______________________________

Product Part #:_______________________________

Quantity_______

Price__________


Shipping & Handling:

United States: Within the United States products are shipped standard two-day UPS based on the following shipping and handling charges:

one item $9.00 ___ two items $10.00 ___ three items $11.00 ___

four items $13.00 ___ five to nine items $18.00 ___

International: International orders are shipped U.S. Air Mail or two-day UPS based on the following shipping and handling charges:

International U.S. Air Mail Shipping Charges:

one item $18.00 ___ two items $21.00 ___ three items $24.00 ___

four items $27.00 ___ five to nine items $30.00 ___

International Two-Day UPS Shipping Charges:

one item $45.00 ___ two items $50.00 ___ three items $55.00 ___

four items $60.00 ___ five to nine items $65.00 ___


Enter Shipping & Handling__________

CA residents please add 7.75% sales tax__________

Enter Total Amount Due__________

Billing Information:

Please Check Type of Payment:

Check Enclosed US $_______ VISA ___ Mastercard ___ AMEX ___ Discover ___

Card Number___________________________________

Name on Card__________________________________

Expiration Date_______________________________


Cardholder Information (if different from Send to):

Name__________________________________________

Street Address________________________________

City__________________________________________

State/Province________________________________

Zip/Postal Code_______________________________

Country_______________________________________

Telephone_____________________________________

Fax___________________________________________

Email_________________________________________


Additional Information:




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