ORDER FORM

NAME  
COMPANY  

 

SHIP TO:

 
Street Address, Suite #
(no P.O. Box addresses)
 
City, State, Zip Code  
Country  
 
BILL ADDRESS:  
Street Address
 
City, State, Zip Code / Postal Code  
Country  
 
PHONE/FAX #
EMAIL
ITEM #
PRODUCT DESCRIPTION
QTY
PRICE
TOTAL

















SubTotal
_______
Sales Taxes (8.75%) (only California orders)
_______
Shipping & Handling
_______
TOTAL
FedEx Overnight
FedEx 2-Day
FedEx 3-Day
UPS GROUND (1 - 7 day delivery)

Circle your choice of shipping method
Call 800-653-4252 or 951-270-1911 for shipping & handling cost


Purchase Order (PO#_______________________
(upon credit approval)

Prepayment by:

  • Cash Bank Deposit
    (call for bank info)

  • Money Order
C.O.D
$10 fee
(only for orders under $300 USD)
Bank Wire Transfer
(call for bank info)
Circle your choice of payment

NOTE: For faster processing, fax (951-304-1267) or email (sales@e-scan.com) your order form and/or company PO.







 


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