FAX ORDER FORM & SCHOOL ORDER WORKSHEET

HERZOG Keyboarding 801 E. Cam. de los Padres Tucson, AZ 85718 Ph (520) 792-2550 Fx (520) 792-2551

Method of payment: ____ Credit Card ____ Purchase Order (Schools):          P.O #_________________          NOTE:Minimum P.O. is $20          + tax + Shipping/Handling

Quantity	Product #	Elem. Sec.	Description	Price	Line Total

*SHIPPING & HANDLING If Subtotal Amount Is: • Under $100.00:   Call us for amount • Over $100.00:     Shipping & Handling is 10% of Subtotal.	SUBTOTAL *SHIPPING & HANDLING SALES TAX 8.2% (Arizona Only) TOTAL
Additional Shipping Charges Outside of Continental U.S., and for Expedited Shipment.

Credit Card Information

______________________________________________ Credit Card Number ____________________________       ______________ Card Expiration Date                          Security Number ______________________________________________ Name on Card ______________________________________________ Billing address for card Street ______________________________________________ Billing address for card City/State/Zip ______________________________________________ Signature

__(_______)____________________________________ Phone (Day) __(_______)____________________________________ Phone (Evening) __(_______)____________________________________ Your Fax Number ______________________________________________ Your E-mail Address

Bill To: ______________________________________________ District/School ______________________________________________ Address ______________________________________________ City/State/Zip ______________________________________________ Authorized by __(______)_____________________________________ Phone

Ship To: ______________________________________________ Person/District/School ______________________________________________ Address ______________________________________________ City/State/Zip ______________________________________________ Attn:

PLEASE SPECIFY OUR PRODUCT # & 'ELEMENTARY' OR 'SECONDARY' ON YOUR PURCHASE ORDER

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