Fax this form to: (561) 828-6397
or mail to: Klos Technologies, Inc., 12 Jewett, Cortland,
New York, 13045
Check, money order, or company purchase order accepted.
International orders require pre-payment by check unless other arrangements are made.
Product Price/Unit Quantity Total PacketView Pro $999.00 ______ ______ PacketView $299.00 ______ ______ SerialView $399.00 ______ ______ Shipping Charges (see below) Item number ______ ______ Total Amount ($U.S.) ______
Payment and Shipping Information Name:_____________________________________________________________________ Company:__________________________________________________________________ Address:__________________________________________________________________ City:_________________________________ State/Province:____________________ Zip/Postal Code:______________________ Country:___________________________ Phone:________________________________ Fax:_______________________________ Email:________________________________ Add me to product updates mailing list: ___ Yes ___ No Payment: Moneyorder ____ Check ____ Purchase Order ____ (please fax P.O.) Signature:____________________________________________ Date:______________
Shipping and Handling Charges Within the United States PacketView Pro Item No. PacketView SerialView 1 FedEx Priority (am) $15.00 $21.50 2 FedEx Standard (pm) 13.00 19.00 3 FedEx 2/3-Day (pm) 9.25 10.00 * Add $2.00 for each additional unit ordered Canada 4 FedEx International 34.00 36.00 * Add $5.00 for each additional unit ordered For all other international shipments, send email to Sales or call (603) 714-4305 for the shipping charge. For wire transfers, use the following routing and transit information: Tompkins Trust Company PO Box 460 Ithaca, NY 14851 www.tompkinstrust.com RoutingAcct #