GRAPHIX SAVERS
                     GRAPHIX SAVERS ORDER FORM
                                                              

Graphix Savers:                                                             QTY.                                  Total

  27”
Polycarbonate (Lexan) with bolt kit          $15 / pr.      _______      x  __$15____ =  _________
  
            HOLES PRE-DRILLED with COUNTERSINK
                                                  
                              Shipping:
                                           1 -set                                                                                     $ 5.00
                                           2 - 8 sets                                                                                $ 3.00
                                           9 or more sets FREE SHIPPING


                                                                                                   TOTAL ORDER: ____________


Ship to:

Name:____________________________________________

Business Name (if Applicable):________________________

Address:_____________________________

City:________________________________

State:__________      ZIP:_______________

Phone: (         )  ______________________  

E-Mail: ______________________________

Make Payment to:

Jon Taylor
12415 Cobblestone Court
Indianapolis, IN.  46236

(317) 826-0863
www.graphixsavers.com
graphixsavers@sbcglobal.net


Payment by Money Order or Personal check (shipment will be delayed 3-days for check to clear)