CW-105F ORDER FORM
(TEXT VERSION — Please print out & use when MAILING or FAXING your order)


Order By Mail: Print out this order form, and send it along with US FUNDS check or Money Order, or credit card information to:

Vortech, Inc.
PO Box 511-W
Fallston, MD 21047

Order By Fax: Print out this order form, and fax it along with credit card information:

410-668-8518

Order By Phone (24 hours a day): Have your credit card handy, and call:

410-663-8022



Your e-mail address: ________________________________________________

Your Name: ______________________________________________________

Address:_________________________________________________________

City: ____________________________________________________________

State / Province: ______________ Zip / Postal Code: ______________________

Country (if not USA) _______________________________________________

Phone: _______________________________ Fax:____________________________


       Please send me (prices include postage):

___ CW-105F Pland @ $275 U.S.,  $298 foreign: $______________

SUB-TOTAL $_____________

SALES TAX (Maryland residents only, add 6%)_____________

All remittances in US FUNDS only, please.

TOTAL $ _____________


CREDIT CARD INFORMATION

(We accept VISA, MASTERCARD, AMERICAN EXPRESS & DISCOVER)

CARD TYPE (check one)  ___VISA  ___MASTERCARD  ___AMEX   ___DISCOVER

CARD NUMBER: _____________________________________________________

EXPIRATION DATE: (in the form mm/yyyy; such as, 08/2020): _______________________

NAME APPEARING ON CARD: _________________________________________


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