Order Form - MicroWiz, Yuma, AZ 85364 (928)344-1626 www.micro-wiz.com

Use this Order Form to place your order. Please Fill out the form and then click on the PRINT button. Mail, Fax, or Email your order to us. If you prefer fill-able PDF File, please click here (requires Adobe Acrobat Reader). This form is only an Order form, no information is transmitted, it resides in your computer as a temporary internet file, the information you type is NOT automatically saved or transmitted through the internet. By placing an order, you agree to the terms and conditions listed at www.micro-wiz.com/sales.html. Email or Mail complete orderform.

Item Name	Description	Qty	Unit Price	Amount U.S. $





	MAILING ADDRESS:		Subtotal
	MicroWiz /Sales Dept.		S/H
	PO Box 4035, Yuma, AZ 85366-4035
	Standard Shipping for most orders $5.85		Total

CUSTOMER INFORMATION

Name

Company
Address
City/ST/Zip
Telephone
E-mail

Address above is Residential Business

PAYMENT TYPE:
CHECK (must fill out check section)
MONEY ORDER
PAYPAL (no credit/debit cards Accepted)

Use Paypal account balance, e-check, or bank account attached to Paypal.

CHECK PAYMENTS

Driver's Lic#
State/ Exp.

There is a $35 fee for ALL RETURNED Checks. 18% Restocking fee on all approved merchandise returns (RMA required).

Please read our complete Sales Terms.

Signature _______________________________

Complete sections above for check payments. Make check or money order payable to "MicroWiz".

Thank You for Choosing MicroWiz!

Mail or Email complete Order form to SALES@MICRO-WIZ.COM WEBSITE: WWW.MICRO-WIZ.COM