Scanmix Corporation

PRINTABLE ORDER FORM

You can fax orders along with credit card information to 1-207-782-1914 or mail them along with check, money order or Visa/MasterCard to Scanmix Corporation, 36 Hogan Rd.., Lewiston, ME 04240. Call us at (207) 782-1885 or email us anytime.

Billing Address Shipping Address (if different)

Name: Name:

Address Address

City, ST, Zip: Phone:

email: Fax:

Model #	Description	Quantity	Price Each	Total Price

Subtotal
Maine Tax 5%*
Shipping*
Total

Method of Payment:

Check or Money order Enclosed: ________
Credit Card: Visa_____ MasterCard _____
Card #	Name on Card:
Exp. Date	Signature:

The following shipping charges will be added to your order shipped within the U.S.A. $12 shipping per shower set or faucet ordered, add $8 per additional set shipped to the same address in the U.S.A..

When shipped within the state of Maine, we are required to charge a 5% sales tax.

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Billing Address	Shipping Address (if different)
Name:	Name:
Address	Address
City, ST, Zip:	Phone:
email:	Fax: