DEAFWORKS - ORDER DEPT
P.O. Box 1265  -  Provo, UT    84603-1265
TTY: (801) 465-1957   FAX: (801) 465-1958

E-mail:
 
Date:  
P.O. #:  
  Contact & Shipping information:
NAME:  
COMPANY NAME:  
ADDRESS 1:  
ADDRESS 2:  
CITY:  
STATE:  
ZIP CODE:  
TTY:  
VOICE:  
FAX:  
E-MAIL:  
  Order Information:
Item Qty Stock# Description Amount
1        
2        
3        
SUB-TOTAL:  
(Utah - 6.25%) SALES TAX:  
[UPS RED (Next Day) - $40, BLUE (2nd Day) - $30, ORANGE (3rd Day) - $20,                                          
or GROUND (Surface, up to 8 days) - $8.50]
                                                 SHIPPING:
 
GRAND TOTAL:  
  Payment Information:
CHECK #:  
MONEY ORDER #:  
VISA or DISCOVER #:  
MASTERCARD #:  
EXP DATE:  
SIGNATURE (CC only):