You can print a hardcopy of this page on your printer, then FAX your order to us at 1-626-793-3797
or mail it to Pentrex, P.O. Box 94911, Pasadena, CA 91109-4911.
We accept checks, money orders, and Visa, MasterCard, Discover, and American Express charge cards.
QTY. ITEM CODE # ITEM DESCRIPTION EACH TOTAL
         
         
         
         
         
         
         
         
         

Orders or Customer Service

1-800-950-9333

FAX us your order at 1-626-793-3797

*CANADA include $14.00 per order plus $1.00 for each additional item. Payment only by Visa, MasterCard, Discover, American Express, Canadian POSTAL Money Order or INTERNATIONAL Money Order in U.S. funds. ALL OTHER COUNTRIES include $17.00 per order plus $4.00 for each additional item. Payment by Visa, MasterCard, Discover, American Express or INTERNATIONAL Money Order in U.S. funds.

MERCHANDISE TOTAL  
 Calif. residents add 8.25% sales tax   
U.S. SHIPPING & HANDLING:
First Item: - $5.00 Plus $1.00 For
Each Additional Item
(for each mailing address)		  
*Foreign Shipping  
TOTAL  

(PLEASE PRINT CLEARLY)

Name:______________________________________

Address:____________________________________

City:_______________________________________

State:________ ZIP:___________________________

Country:____________________________________

Daytime Phone: (      )_______________________

Fax Number: (      )_________________________

 

SHIP TO: (if different address)____________________

__________________________________________

__________________________________________

__________________________________________

__________________________________________

__________________________________________

Customer I.D.#:_____________________________

PLEASE ALLOW 2-4 WEEKS FROM RECEIPT OF YOUR ORDER FOR DELIVERY

  Payment Method:

  • Check
  • Money Order
  • Visa
  • MasterCard
  • Discover
  • American Express
  Card Account No. |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

  Expiration Date (Required) Month |__|__| Year |__|__|

  Customer Signature_____________________________________

  Date_________________________________________________

 For office use only
RECD:
C#:
Pmt.Meth:
AMT:
ENT'D:
ORD#: