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| | | Order Form | | |
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| | | Order Online! Fast, Easy, 24/7 www.DicksonData.com | | |
| | | Phone: 1-800-323-2448 • Fax: 1-800-676-0498 Mail: Dickson 930 S. Westwood Ave., Addison, IL 60101 | | |
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| | | STEP 1 - BILL TO: Name: Company: Address: City:_ State/Province: Zip: Phone: E-mail: STEP 2 - SHIP TO: (IF DIFFERENT THAN BILLING) Name: Company: Address: City:_ State/Province: Zip: Phone: | | |
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| | | STEP 3 - ORDERING INFORMATION: | | |
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| | | | | | | | | | | | | Model Number 1 1 1 1 1 | I I I I | Quantity | Price/Unit I $ /ea | Total $ | | | | 1 1 1 1 1 | I I I I | | | | I $ /ea | $ | | | | 1 1 1 1 1 | I I I I | | | | I $ /ea | $ | | | | N100 (New Unit 1-pt NIST Calibration) | | | | I $ 99/ea | $ | | | | | | In Illinois, add 7.5% sales tax 4 Tax: Freight*: All Prices in U.S. Dollars 4 Total*: | $ $ $ | | | | STEP 4 - PAYMENT METHOD: | U.S.A. FREIGHT CHARGES* | | | | | | | | | | | | | |
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| | | □ Check: Check# □ Money Order (enclosed with order) □ Credit Card: □ □ □ |TBT| Credit Card Number: □ □□□"□□□□-□□□□-□□DD Expires: (mm/yy) □ □ /□□ □ Purchase Order: P.O.# Customer Number: (Net 15 days for established customers) | | |
| | | UPS 2nd Day $20 $25 | | UPS UPS Next Ground $41 $13 | | |
| | | Total Order | | |
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| | | $0-100 | | |
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| | | $101-400 | | | $53 | | $19 | | |
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| | | $401-700 | | $35 | | $69 | | $22 | | |
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| | | $701-1,000 | | $45 | | $74 | | $32 | | |
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| | | $1,001-1,500 | | $67 | | $93 | | $47 | | |
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| | | $1,501-2,000 | | $88 | | $117 | | $56 | | |
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| | | $2,001-over Please call Dickson Customer Service All shipments UPS 2nd day unless otherwise requested. *All prices and freight charges subject to change without notice | | |
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| | | Signature | | |
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| | | Complete product specifications and accessories at www.DicksonData.com DICKSON 9 | | |
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