| ITEM# | QTY | DESCRIPTION | PRICE EACH | AMOUNT |
| SUBTOTAL | ||||
| 6% PA SALES TAX | ||||
| SHIPPING | ||||
| TOTAL |
| MERCHANDISE TOTAL | UP TO $25.00 | $25.01 TO $50.00 | $50.01 TO $75.00 | $75.01 TO $100.00 |
$101.00 TO $150.00 | $150.01 TO $250.00 | $250.01 + CALL |
| DELIVERY CHARGES | $4.95 | $5.95 | $7.95 | $8.95 | $10.95 | $13.95 | $14.95 |
Please print legibly.FULL NAME:_____________________________________________________
BUSINESS NAME:_________________________________________________
STREET ADDRESS:________________________________________________
_______________________________________________________________
MAILING ADDRESS IF DIFFERENT:__________________________________
_______________________________________________________________
CITY:__________________________________________________________
STATE/PROVINCE:______________________________ZIP+4:_______-____
COUNTRY:_______________________________________________________
PHONE INLUDING AREA CODE:______________________________________
BUSINESS PHONE:___________________________FAX:_________________
E-MAIL ADDRESS:________________________________________________
SIGNATURE:_____________________________________________________
By signing you are stating you are 18 years of age or older. PURCHASE ORDER NO._____________________________________________
If Applicable
PAYMENT METHOD
VISA______MASTER CARD______AMEX______
CREDIT CARD #:_ _ _ _ /_ _ _ _ /_ _ _ _ /_ _ _ _EXPIRATION DATE:_ _/_ _
SIGNATURE REQUIRED:_______________________________________ CHECK:______COMPANY CHECK:______MONEY ORDER:______OTHER:______
Quoted prices are in U.S. Dollars. RRMS SECURITY PRODUCTS
and SERVICES
431 WILLOW ROAD
WALNURPORT, PA 18088-9653
U.S.A.
Voice:(610)760-8372/Fax:(610)760-0676/Toll Free:1-888-760-8372
E-mail:rrms1@enter.net or rrms1secure@hotmail.com
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