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. FAX / MSG. (928) 344-1626

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





	MAILING ADDRESS:		Subtotal
	MicroWiz /Sales Dept.		Postage
	PO Box 4035, Yuma, AZ 85366-4035		3% CC Fee
	S/H for most orders under 1lb $5.85, 2lbs $7.75, 3 lbs. $10.55. We also ship via FedEx		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
CREDIT CARD (There is a 3% surcharge on all credit card orders under $150. Excludes cash/money order/check orders.

PAYPAL (no credit/debit cards Accepted)

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

Please read our complete Sales Terms.

CHECK PAYMENTS

Driver's Lic#
State/ Exp.

CREDIT CARD PAYMENTS (not available for International Orders)

VISA MasterCard

Card No.
Name
Exp. Date & Zip

Signature _______________________________

Complete sections above for check or credit card payments. Make check or money order payable to "MicroWiz". There is a 3% surcharge on orders UNDER $150 on non-cash, non-check, non-money order payment.

Thank You for Choosing MicroWiz!

Sales Fax / Msg (928) 344-1626 EMAIL: SALES@MICRO-WIZ.COM WEBSITE: WWW.MICRO-WIZ.COM