| Tandem Associates LLC, P.O. Box 245, Whitmire, SC 29178-0245 E-mail: tandem@tandem-associates.com Plasticville Parts Order Form |
| 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 _____ |
| Part # | Description | Quant. | Price | Total Price |
|---|---|---|---|---|
|
Insurance: --- $1.65 for orders under $200 Shipping Rates for US Shipments: --- $4 for orders under $25, --- $5 for orders totaling $25 up to $50 International orders: please contact us for our rates. |
Sub-total | |
|---|---|---|
| 6% SC Sales Tax | ||
| Insurance | ||
| Shipping | ||
| TOTAL AMOUNT |