BRENT JESSEE RECORDING & SUPPLY, INC. FAX/MAIL ORDER FORM (Print a copy of this order form for FAX or mail-in orders) FAX: 847-963-1568 NAME______________________________________________________ ADDRESS___________________________________________________ CITY_____________________________STATE______ZIP___________ PHONE____________________________E-MAIL___________________ PART #___________DESCRIPTION_______________________QTY___PRICE____TOTAL_____ PART #___________DESCRIPTION_______________________QTY___PRICE____TOTAL_____ PART #___________DESCRIPTION_______________________QTY___PRICE____TOTAL_____ PART #___________DESCRIPTION_______________________QTY___PRICE____TOTAL_____ PART #___________DESCRIPTION_______________________QTY___PRICE____TOTAL_____ PART #___________DESCRIPTION_______________________QTY___PRICE____TOTAL_____ ILLINOIS RESIDENTS ONLY: Add 10% tax to your order SUBTOTAL____________________ TAX__________________________ SHIPPING_____________________ TOTAL_______________________ USA SHIPPING: USPS Mail $12.00 up to 2 lbs. with insurance for up to $50 in merchandise included, for additional coverage add $1 per $50 in merchandise over the first $50. CANADA: $32 USD flat rate USPS priority mail up to 4 lbs. INTERNATIONAL: $41 USD flat rate USPS priority mail up to 4 lbs. Personal check, cashier's check, money order, business check or traveller's cheques accepted. We also accept Master Card, Visa, American Express, or Discover credit cards. Please indicate name on card, card number, expiration date, and the three digit number on the back of the card. CREDIT CARD ORDERS ONLY: CARD TYPE_______________________ CARD NUMBER________________________________ EXPIRATION DATE_________________ 3-DIGIT CODE (on back of card)_____________ PRINT A COPY OF THIS ORDER FORM, FILL IT IN, AND FAX/MAIL/EMAIL WITH YOUR PAYMENT TO: BRENT JESSEE RECORDING 1590 W. ALGONQUIN RD. #111 HOFFMAN ESTATES, IL 60192 FAX ORDERS: Please print out this form, fill out in dark ink including your credit card information, and fax to 847-963-1568, 24 hrs. a day, any day. For full warranty and return policy, please see www.audiotubes.com/warranty.htm online.