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Date _____________
Name ___________________________________
Address _________________________________
City _____________________ State ______ Zip __________
Telephone ( _____ ) ______ - ________
Mail To:
Pro Tek Covers
P.O. Box 1116
Placerville, CA 95667
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| Payment Information (Circle One) |
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CHECK
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PAYPAL E-MAIL ADDRESS
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Qty |
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Cost |
| Table Covers |
| Red |
_______ |
x $105 |
_________ |
| Blue |
_______ |
x $105 |
_________ |
| Black |
_______ |
x $105 |
_________ |
| Forest Green |
_______ |
x $105 |
_________ |
| Showcase Inserts |
| Red |
_______ |
x $10 |
_________ |
| Blue |
_______ |
x $10 |
_________ |
| Black |
_______ |
x $10 |
_________ |
| Forest Green |
_______ |
x $10 |
_________ |
| Showcase Covers |
_______ |
x $60 |
_________ |
| Table Lamp Clamps |
_______ |
x $20 |
_________ |
Subtotal |
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_________ |
Add Sales Tax for CA 8.25% |
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_________ |
Shipping & Handling |
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1 or 2 Table or Showcase Covers $15.00 |
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_________ |
1 or 2 Inserts or Clamps $10.00 |
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_________ |
Total Enclosed |
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