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(Please print out and send with order.)
Name_________________________________________________________ Street Address__________________________________________________ City__________________________ State________ Zip Code____________ Date_____________ Phone#_______________________________________
ITEM________________________________ QNTY_____PRICE__________SUB______ ITEM________________________________ QNTY_____PRICE__________SUB______ ITEM________________________________ QNTY_____PRICE__________SUB______ ITEM________________________________ QNTY_____PRICE__________SUB______ ITEM________________________________ QNTY_____PRICE__________SUB______ ITEM________________________________ QNTY_____PRICE__________SUB______ ITEM________________________________ QNTY_____PRICE__________SUB______ ITEM________________________________ QNTY_____PRICE__________SUB______ ITEM________________________________ QNTY_____PRICE__________SUB______ |
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SUBTOTAL ______________ CA only: add 8.25% SALES TAX______________ GRAND TOTAL ____________ |
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Send check or money order to: MUCID 729 Heinz Ave. Suite #4 Berkeley, CA 94710 |