ORDER FORM

JAMES RAINHO PRODUCTS - SIMPLEX MAGIC
14 Windsor Rd. - Medford, MA 02155 - USA
Phone:(781)391-4104
Email: magicjim@rainho.com
ORDER FORM
FOR STANDARD MAIL ORDERS ONLY - TO BE PAID BY CHECK OR MONEY ORDER
(IN US DOLLAR for International Orders)

FROM: (CustomerInformation Date:_________________________________ NAME:_____________________________________________ ADDRESS:_________________________________________ CITY:______________________________________________ STATE/PROVINCE:__________________________________ POSTAL CODE:_____________________________________ COUNTRY:_________________________________________ TELEPHONE NUMBER:______________________________ EMAIL:_____________________________________________

TO BE SHIPPED TO: (If same as on left - write "same" on first line) NAME:___________________________________________ ADDRESS:_______________________________________ CITY:____________________________________________ STATE/PROVINCE:________________________________ POSTAL CODE:___________________________________ COUNTRY________________________________________

ITEMS ORDER ...NO.---/--QTY.-/-----------------------------ITEM NAME----------------------/- UNIT PR.--/--TOTAL 01/______/______/_____________________________________________________/_________/__________ 02/______/______/_____________________________________________________/_________/__________ 03/______/______/_____________________________________________________/_________/__________ 04/______/______/_____________________________________________________/_________/__________ 05/______/______/_____________________________________________________/_________/__________ 06/______/______/_____________________________________________________/_________/__________ 07/______/______/_____________________________________________________/_________/__________ 08/______/______/_____________________________________________________/_________/__________ 09/______/______/_____________________________________________________/_________/__________ 10/______/______/_____________________________________________________/_________/__________ 11/______/______/_____________________________________________________/_________/__________ 12/______/______/_____________________________________________________/_________/__________ 13/______/______/_____________________________________________________/_________/__________ 14/______/______/_____________________________________________________/_________/__________ 15/______/______/_____________________________________________________/_________/__________ 16/______/______/_____________________________________________________/_________/__________ 17/______/______/_____________________________________________________/_________/__________ 18/______/______/_____________________________________________________/_________/__________ 19/______/______/_____________________________________________________/_________/__________ 20/______/______/_____________________________________________________/_________/__________ 21/______/______/_____________________________________________________/_________/__________ 22/______/______/_____________________________________________________/_________/__________ 23/______/______/_____________________________________________________/_________/__________ 24/______/______/_____________________________________________________/_________/__________ 25/______/______/_____________________________________________________/_________/__________ PRODUCTS TOTAL DOLLAR AMOUNT:__________________ SHIPPING METHOD(Ground or Air):___________SHIPPING/HANDLING FEE:___________________ INSURANCE FEE:__________________ MASSACHUESETTS CUSTOMERS - ADD 6.25% SALES TAX:__________________ TOTAL:___________________ -

FOR SHIPPING/HANDLING FEES & INSURANCE FEES
CLICK HERE TO GO TO SHIPPING INSTRUCTIONS PAGE.
This applies ONLY to orders to be processed by mail.
PRINT OUT ORDER FORM ABOVE
Fill it in and mail it with check or money order to address above.

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