FAX ORDER FORM & SCHOOL ORDER WORKSHEET

HERZOG Keyboarding

8437 N. Coral Ridge Loop
Tucson, AZ 85704
Ph (520) 792-2550
Fx (520) 792-2551

Method of payment:
____ Credit Card
____ Purchase Order (Schools):
         P.O #_________________
         NOTE:Minimum P.O. is $20
         + tax + Shipping/Handling

Quantity

Product #

Elem.
Sec.

  Description

Price

Line
Total

           
           
           
           

*SHIPPING & HANDLING
If Subtotal Amount Is:

• Under $100.00:   Call us for amount
• Over $100.00:     Shipping & Handling is 10% of Subtotal.

SUBTOTAL
*SHIPPING & HANDLING
SALES TAX 8.2% (Arizona Only)
TOTAL
 
 
 
 
Additional Shipping Charges Outside of Continental U.S., and for Expedited Shipment.

Credit Card Information
______________________________________________
Credit Card Number
____________________________       ______________
Card Expiration Date                          Security Number
______________________________________________
Name on Card
______________________________________________
Billing address for card Street
______________________________________________
Billing address for card City/State/Zip
______________________________________________
Signature
__(_______)____________________________________
Phone (Day)
__(_______)____________________________________
Phone (Evening)
__(_______)____________________________________
Your Fax Number
______________________________________________
Your E-mail Address

Bill To:

______________________________________________
District/School
______________________________________________
Address
______________________________________________
City/State/Zip
______________________________________________
Authorized by
__(______)_____________________________________
Phone

Ship To:

______________________________________________
Person/District/School
______________________________________________
Address
______________________________________________
City/State/Zip
______________________________________________
Attn:

PLEASE SPECIFY OUR PRODUCT # & 'ELEMENTARY' OR 'SECONDARY' ON YOUR PURCHASE ORDER

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