To order, print out the form below, fill in and fax to 414-962-4374

ORDER FORM

ITEM #

PRODUCT

 QTY PRICE

TOTAL PRICE
         
         
         
         
         
         
         
         
         
         
 

 MERCHANDISE TOTAL

      
         
 

  Sales Tax (Residents Only)

      
 

 SHIPPING (see chart)

      
 

 TOTAL AMOUNT

      

 

 -- GUARANTEE --
Satisfaction is guaranteed or your money will be refunded.


Allow a minimum of 2 weeks for delivery.
All items shipped UPS Pre-paid.

Delivery charge per address
Continental U.S. Only
If order totals:

Add
Up to $25.00    $4.50
$25.01 to $55.00 $7.50
$55.01 to $100.00 $11.50
$100.01 to $150.00 $15.50
Over $150.01 12%
For delivery outside contiguous United States, call 414-962-43741 for exact charges. 


OR CALL : 414-962-4374

 

ORDERED BY:
 NAME  _______________________________________
ADDRESS  _______________________________________
   _______________________________________
CITY, STATE, ZIP  _______________________________________
DAYTIME PHONE  _______________________________________
   

SHIP TO (IF DIFFERENT FROM ABOVE):
 NAME  _______________________________________
ADDRESS  _______________________________________
   _______________________________________
CITY, STATE, ZIP  _______________________________________

PAYMENT METHOD
 

Corporate and Government clients can use Purchase Order Numbers. 

Purchase Order # _________________________
   ____ Check          _____ Money Order
 Charge to my:  ____ Visa       ____ MasterCard
 Credit Card #  _______________________________________
 Expiration Date  _________________
   
Authorized Signature  ________________________________________
 
 

Corporate and Government clients can use Purchase Order Numbers. 

Purchase Order # _________________________
 


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R P R Corporation
708 E. Beaumont Ave.
Milwaukee, WI 53217
Phone: 414-962-4374
Fax: 414-962-4374


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