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Order form, Name (please print), Address – Avanti BD555 User Manual

Page 2: City, State, Daytime phone ( ), Enclosed is, Credit card number expiration date, Signature, Please make checks payable to: avanti products

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ORDER FORM

Avanti Products, P.O. Box 520604, Miami Florida 33152

For your convenience, you may use a major credit card (Master Card, or Visa) to order accessories over the phone by calling (800) 220-5570.

To order by mail, please fill out the following form and send it in with your payment (check, money order or credit card) using the above address.

NAME (please print)

ADDRESS

CITY

Qty

Item

Description

Price

Total

SH-1

2 SHELVES

9.95

CS-2

2 CASTERS

9.95

SUBTOTAL

SHIPPING AND HANDLING

$ 6.25

TOTAL

$

STATE

ZIP

ACCESSORIES SUBJECT TO AVAILABILITY

DAYTIME PHONE (

)____

ENCLOSED IS

$

IJcHECK pMONEY ORDER [J

m

ASTER CARD []viSA

CREDIT CARD NUMBER

EXPIRATION DATE

NAME

(AS IT APPEARS ON CREDIT CARD)

SIGNATURE

(OF CREDIT CARD HOLDER)

PLEASE MAKE CHECKS PAYABLE TO: AVANTI PRODUCTS

Avanti has a policy of continuous improvement on its products and reserves the right to change materials and specifications without notice.