ZAREX SCORES ORDER FORM for MAIL or FAX
Mailing Address:
ZAREX CORP
PO BOX 8338
SOUTH BEND, IN 46660-8338 USA

FAX number:

USA FAX: 574 . 271-9191

All products at ZAREX.COM are priced in U. S. DOLLARS. PLEASE ENTER ALL PRICES IN U. S. DOLLARS AS SHOWN AT WWW.ZAREX.COM . If your currency is other than U. S. Dollars, ZAREX shall calculate the exchange rate at the time of processing, and your MasterCard or VISA shall be charged the equivalent amount in your local currency.

Ship to name:
________________________________________________________


Ship to address:__________________________________________________________


Ship to city/state/zip:________________________________________________________

telephone /email /or FAX:_____________________________________________________

Please send the following

quantity___ item#________ description /title ______________________

ext. amt $_____

quantity___ item#________ description /title ______________________

ext. amt $_____

quantity___ item#________ description /title ______________________

ext. amt $_____

quantity___ item#________ description /title ______________________

ext. amt $_____

  Total amount for goods ordered:

$_______

  Indiana residents only, add 7% state sales tax:

$________

  Add applicable postage: $6 per total order to USA/ Canada (Priority Mail).
$12 per order shipped everywhere else worldwide (Global Priority Mail).

$________

  GRAND TOTAL:

US $_______


Account #: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ exp month/ year _____/_____
Thank you for your order!

Copyright 2011 Zarex Corp. All Rights Reserved.