MicroMac Technology Online Order Form

To Place an Order:

1. Fill out the online order form with the necessary shipping, product and billing information. If you wish to have a sales representative confirm your credit card number over the phone for security purposes, type CALL in the credit card number field.
2. When you have completed the order to your satisfaction, click on the PLACE ORDER button at the bottom of the form to place your order.
3. Online order forms are processed by the sales department between the hours of 8:30 am and 5:00 pm PST/PDST, Monday through Friday. Once an order is processed, a sales representative will contact you to confirm your order and billing information.

As a courtesy to our customers, we do not sell or distribute mailing lists. Your identity and information are confidential.

Your Send to Information:

First Name: Last Name:
Company: ...
Address: ...
Address: ...
City: ...... State: Zip:
Country: ...
Phone: ..... ...Fax:
e-mail: ....

Product:

Select the appropriate MicroMac Product Part #. (Refer to product page for appropriate part numbers.)

Product: 72-pin SIMM

Product Part #: MEM4M-72p-70       $19 MEM8M-72p-70      $29 MEM16M-72p-70     $59 MEM32M-72p-70     $99

Quantity for item selected: 1 2 3 4 5 6 7 8 9 10

- Enter Price


Shipping & Handling:

		one item	two items	three items
Domestic (USA)	2-day (UPS)	$5.00	$8.00	$10.00
International	Air-Mail	$12.00	$14.00	$15.00

- Enter Shipping & Handling from table above

- Enter Total Amount Due (add Price + Shipping&Handling)

No,Yes - CA residents (7.75% sales tax will be added if product is shipped to a CA address)

Billing Information:

Credit Card Information:
Card Type: .......Visa, MasterCard, AMEX, Discover
Card Number: .....
Expiration Date: . use this format "04/00"
Name on Card: ....

Cardholder Information (if different from Send to):
First Name: Last Name:
Company: ...
Address: ...
Address: ...
City: ...... State: Zip:
Country: ...
Phone: ..... Fax:
e-mail: ....


If you need to clarify any information, please enter additional
comments in the field below: