ORDER FORM
Name:____________________________________________________________________________________________________
Street :
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City: ___________________________________ | State: __________________ | Zip: _____________ | |||||
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Ship To: (if different from above)
Name:
______________________________________________________________________________________________
Street:
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City: ____________________________________ | State: _____________________________________ Zip: |
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Ordering:
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| Quantity | Part # |
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| Method of Payment: (No C.O.D.’s) Circle One (MASTER CARD), (VISA), (DISCOVER) |
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| CARD #_______________________________________________________________ exp. date |
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| For Cashier’s Check or Money Order please list Driver’s license # /State: |
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| _______________________________________ |
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| Call for appropriate freight charges . |
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| Total from above | $ _____________ |
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| Jumpking, Inc. |
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| State Sales Tax (Texas only) | _____________ |
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| 901 W. Miller Road |
| Handling Charge | 5.00 |
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| P. O. Box 461806 |
| Freight Charge | _____________ |
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| Garland, TX 75041 |
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Mail to:
Jumpking, Inc.
901 W. Miller Road
P.O. Box 461806
Garland, TX 75041
Page 14