Tandem Associates LLC, P.O. Box 245, Whitmire, SC 29178-0245
E-mail: tandem@tandem-associates.com
Customer Order Form
  

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Name __________________________________________________________
Address __________________________________________________________
City, State, Zip____________________________________ , _______ , ____________
SHIPPING Address__________________________________________________________
(if different) __________________________________________________________
City, State, Zip____________________________________ , _______ , ____________
Phone: Home (_____) - ______ - ________ Work (_____) - ______ - _________
Fax # (_____) - ______ - ________ E-mail ________________________
Payment: Personal or business check ______ ; Money order or certified check _____

Catalog #Description & ConditionAmount
   
   
   
   
   
   
   
   
   
   
   
Shipping & Insurance Rates for US Shipments:
--- $9 for orders under $50,
--- $14 for orders totaling $50 up to $100
--- $18 for orders over $100
International orders: please contact us for our rates. 		Sub-total  
6% SC Sales Tax  
Shipping & Insurance  
TOTAL AMOUNT  

Signature ________________________________________________ Date _____________