OrionWorks  & Darlene P. Coltrain
Purchase Order Form
 (Print this form. Mail or FAX your order)

MAILING ADDRESS:
OrionWorks, 2701 University Ave, PO #343, Madison WI 53705

PHONE (voice): (608) 231-2040
FAX: (608) 231-2524

ITEM NUMBER TITLE DESCRIPTION UNIT PRICE QTY TOTAL PRICE
     
     
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  . .
  . .
  . .
  . .
SUB TOTAL:   
Canadian Orders add 25% Surcharge:   
Wisconsin purchases add 5.5% Tax from SUB TOTAL amount:   
SHIPPING,  HANDLING and INSURANCE: 
Add $10.00 for orders from $0.00 but less than $100.00
For all orders over $100.00 add 10% from SUB TOTAL amount 		 
GRAND TOTAL:   

Method of Payment

[_] Check Enclosed, Make checks payable in USA Dollars to: OrionWorks or Darlene P. Coltrain
[_] Credit Card: (We can only accept Master Card or VISA)
[_] VISA [_] Master Card
Credit Card No:
Expiration Date:
Signature:

Shipping Address

Name:
Address:
City:

 		State:
 		Zip:
Country:

 		FAX:
Phone:
Email Address:
TERMS: We will do our absolute best to process and ship your order within 48 hours. Please allow 4 - 6 weeks for delivery, particularly when we are out on business trips. If you have any questions call (608) 232-2040 in mornings or evenings Central Standard Time. Questions can also be EMAILed to: svj@orionworks.com. Please include the ITEM TITLE in subject line in subject line of email message.