Ingram Technologies Mail In Order Form

Print this form, fill it out completely, then MAIL to:
Ingram Technologies, LLC
Rt. 2 Box 2169
Roosevelt
Utah 84066
(435)722-2597 Fax:(435)722-2599

  --------- SHIPPING NAME AND ADDRESS ----------------------------------------------------
 
  Name___________________________________________ 
  Address________________________________________ 
  City/State/Zip_________________________________ 
  Country_________ Day Phone ____________________ 
  E-Mail Address__________________________________________________ 


  ------------------------------------------- ORDER --------------------------------------
 
    QTY   ITEM CODE                       DESCRIPTION                         PRICE
   ____ ____________ ______________________________________________________ __________
   ____ ____________ ______________________________________________________ __________
   ____ ____________ ______________________________________________________ __________
   ____ ____________ ______________________________________________________ __________
   ____ ____________ ______________________________________________________ __________
   ____ ____________ ______________________________________________________ __________

                                                        Subtotal     _____________
                                                        Shipping** + _____________
                                                        Sales Tax* + _____________
                                                        Total        _____________

**Shipping Charges:

      All products are priced to include shipping to addresses within
 the continental US only.

      Charges for shipping outside the US will be billed at the actual shipping
 and insurance rate.
*Items shipped to a Utah address require 6.25% sales tax.
 (price x .0625 = total price)