Watkins Products Customer Order Form

		CUSTOMER ORDER FORM
CREDIT CARD CUSTOMERS FOR CONVENIENT SERVICE CALL TOLL FREE OR BY FAX! FOR ORDER INFO: [email protected]		Sold to:___________________________________________________ Shipping Address___________________________________________ City________________________State____________Zip___________ Day Phone (____) ______________ Evening Phone (____) ___________
		Ship to:___________________________________________________ Shipping Address___________________________________________ City________________________State____________Zip___________ Day Phone (____) ______________ Evening Phone (____) ___________
Article No.	How Many	DESCRIPTION	Price Ea	TOTAL
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Thank You For Your Order!
		Total for Items:		_______
		Minn. Residents add 6 1/2% sales tax on non-food items:		_______
		Shipping and Handling:		___4.95
		AK, HI, U.S. TERRITORIES add $1 shipping/handling for EACH UNIT that requires a shipping surcharge:		_______
		Loss & Damage Protection:		____.50
		TOTAL:		_______
To order directly from WATKINS call toll free:1-800-247-5907 be sure to use your WATKINS Rep ID # 042492 PLEASE CHECK HOW YOU WISH TO PAY [ ] Check or Money Order, Payable to WATKINS (Sorry, no C.O.D. orders) [ ] Visa (13 or 16 digits) [ ] Master Card (16 digits) [ ] Discover (16 digits) Card Number __________________________________ Exp. Date ________ Signature ________________________________________________			YOUR WATKINS REPRESENTATIVE Victoria L Briecke ID#: 042492
Note: For shipment to Alaska, Hawaii, or U.S. Territories, items that require a shipping surcharge are subject to a $1.00 shipping/handling surcharge for each unit ordered. --------------------------------------------------------------------------------------------------------------- To order more than eight (8) items, attach additional order forms and summarize total order on one form.			SEND TO: WATKINS INC. DEPT QS P.O. Box 5570 Winona, MN 55987-0570