|
Name: |
__________________________________________________ |
| Address: |
__________________________________________________
__________________________________________________ |
| City/State: |
__________________________________________________ |
| Country: |
__________________________________________________ |
| Zip
or Country Code: |
__________________________________________________ |
| Telephone
Number: |
__________________________________________________ |
| Email
Address: |
__________________________________________________ |
| OAS
Product Line |
OAS Golfer
-
$99.99 USD/pair OAS
Ultracloud -
$99.99 USD/pair
OAS Ultimate - $99.99 USD/pair OAS Walker
- $99.99 USD/pair
OAS Executive -
$99.99 USD/pair OAS Fashionette - Price:
$99.99 USD/pair
(remember to add
shipping - see below) |
| Order
Details: |
I'll take
_____________ pair(s) of
________________________________________
(name product choice)
at $___________ USD each. |
|
Special Offer: |
indicate your
2 choices on form to be sent with casting kit |
| My
Order Subtotal: |
$_____________________
(Order Subtotal) |
| Shipping
Charges: |
_________ Add
$10.00 USD, if you live in Continental USA
_________ Add $20.00 USD, if you live outside the
USA |
Resident of
Indiana?
If yes, add 6% |
$____________________
Indiana Sales Tax (IN residents only). |
| Order Total: |
$____________________
Total (with shipping and taxes, if
applicable). |
| Payment
Method: |
_______ Check here
if you have enclosed a Check (US accounts only)
or US Funds Money Order. Make
checks/MO's payable to "OAS/MTL
Inc." |
|
Credit Card: |
Card Type:
_____ Master Card _____ Visa (please check
type) |
| Card
Number: |
__________________________________________________ |
| Expiration
Date: |
_____________
Month _____________ Year |
| Name
on Card: |
__________________________________________________ |
| Cardholder
Signature |
__________________________________________________
(required)
|
| Comments: |
_______________________________________________________________________
_______________________________________________________________________
|