Zarex FAX / MAIL Order Form - to print and complete

**ZAREX 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. Ordering terms may be viewed with this link.

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!