N.A.S. INC. ORDER FORM
8682 E. BAYSHORE RD. Date_________19____
MARBLEHEAD, OH 43440 Phone (419)798-4382
Fax (419) 798-9556
____________________________________________________________________________
Name____________________________________
Street Address__________________________ Method of payment:
City_________________State_____Zip______ __Full payment enclosed
__C.O.D. __MasterCharge __Visa
If you want your order Shipped to a
different address..Give information here: Acct. No._______________________
Bank. No._______________________
Name____________________________________ Expir. Date_____________________
Street Address__________________________ Name____________________________
City_________________State_____Zip______ Signature_______________________
Please list your Phone Number:
Area Code(_____)Number__________-_______________
_____________________________________________________________________________
|Page|Stock or | Description | Size | Qty | Price | Total |
| |Model No.| | | | Each | |
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| | | | | | |$ | |
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Approximate shipping cost: |Amount of Mechandise |$ | |
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Orders Up To $50.00 $ 4.00 - $6.50* |Ohio Residents Add 6%|$ | |
$ 50.01 - $100.00 $ 7.00 - $12.00* ----------------------------------
$100.01 - $200.00 $10.00 - $18.00* |Shipping Charges |$ | |
$200.01 - $300.00 $12.00 - $22.00* ----------------------------------
$300.01 - $400.00 $14.00 - $24.00* | TOTAL |$ | |
$400.01 - $500.00 $18.00 - $28.00* ----------------------------------
**CALIFORNIA LAW PROHIBITS SALES Any Lead Products **