| CUSTOM SIGNALS - Sales@CustomSignals.com | |||||
| 27 Gellatly Drive, Wappinger Falls, 12590 (845) 592-1302 | |||||
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ORDER FORM |
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| Name: __________________________________ | Date: ____ / ____ / _______ | ||||
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Street Address: __________________________________ __________________________________ |
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| City / State: __________________________ | Zip Code: __________ | ||||
| Phone: (_______) ____-___________ (Home) | eMail: _____________________ | ||||
| Phone: (_______) ____-___________ (Work) | |||||
| Phone: (_______) ____-___________ (Cell) | |||||
| Quantity | Item # | Description | Unit $ | Amount | |
Sub-Total Amount:   |
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Shipping, and Handling: |
$6.00 |
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NY Residents add 8.25 % Sales Tax: |
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Total Amount: |
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Make checks payable to “CUSTOM SIGNALS”