QualityMathProducts Fax Order Form

GNHC – QualityMathProducts Division

62 Calef Highway Suite 108

Lee, NH 03861
Fax:603-866-2864

Date:___________________

YOUR SHIPPING INFORMATION

YOUR BILLING INFORMATION

Name:__________________________________	Name:__________________________________
Shipping Address:___________________________	Billing Address:_________________________
_______________________________________	_______________________________________
City:_______________________	City:_______________________
State:_____________ Zip:____________	State:_____________ Zip:____________
Country___________________	Country___________________
Phone:____________________________ (Required)*	Your Email:________________________ (Required)*

Item No#  Description  Quantity Price Per Unit Total Price

Sub-Total   Shipping (See Below)   Total Faxed orders received after 2pm CST will be processed on the next business day. Mail In Only, Make Payment to: QualityMathProducts. Order will ship after check clears banking systems. Money orders ship upon receipt. International must supply US Bank Draft for total in US Dollars only.

Card Number:_________________________________________________EXP:________  3-4 Digit Security Code _______ (required!*) Visa, MC, Disc: Last 3 digits on back of card in signature line. AMEX (only) can also be located on front of card 4 digits for older verions of the card.

Clear Signature:_______________________________________________________________ Print Exact Billing Name___________________________________________________

Card CVV2:___________

Shipping
rates as follows:

Regular Shipping	7-10 Business Days	$6.95	No Item Limit
Rush Shipping	3-4 Business Days	$17.95	No Item Limit
International, Military, HI, AK	Quote Only	Contact Customer Service	Contact Customer Service