Super Scanning Service Order Form
AUTOMATIC COMPUTATIONS - MAKES YOUR LIFE EASIER
To select or change quantity (QTY) ALWAYS press TAB KEY to see prices.

Order No./ Title	Qty-TAB	Unit Price	Ext. Price
.	.	Subtotal:

TAXES AND TOTAL CHARGES -- US FUNDS

California Sales Tax is 8.25% (Subtotal)	Check here.
	Total:

CUSTOMER INFORMATION

Name:
Address:
City, State, Zip:
Date Mailed:
Email address:
Your check or money order amount is:

Always print out two (2) copies of your filled-in order form.
Send one to Richard L Swift and keep the second for your files.

Mail Order Form with Check or Money Order to:

Richard L. Swift 514 West Front Street Covina, CA 91722

End of Super Scanning Service Order Form