Jumpking JTR6 User Manual

Page

ORDER FORM

Name:____________________________________________________________________________________________________

Street :
_____________________________________________________________________________________________

City: ___________________________________ State: __________________ Zip: _____________

Home Phone #: ( ) Business Phone # ( )

Ship To: (if different from above)

Name:
______________________________________________________________________________________________

Street:
______________________________________________________________________________________________

City: ____________________________________ State: _____________________________________ Zip:
________

Ordering:

Quantity Part #

Description

Unit

Cost

Total Cost

__________ __________

____________________

___________

_________

__________ __________

____________________

___________

_________

__________ __________

____________________

___________

_________

Method of Payment: (No C.O.D.’s) Circle One (MASTER CARD), (VISA), (DISCOVER)

CARD #_______________________________________________________________ exp. date
____________________

For Cashier’s Check or Money Order please list Driver’s license # /State:
_______________________________________
Call for appropriate freight charges .

Mail to:

Total from above

$ _____________

Jumpking, Inc.

State Sales Tax (Texas only)

_____________

901 W. Miller Road

Handling Charge

5.00

P. O. Box 461806

Freight Charge

_____________

Garland, TX 75041

UPS Charge

_____________

Mail to:

Jumpking, Inc.

901 W. Miller Road

P.O. Box 461806

Garland, TX 75041