AirMax Breather™ Mail Order Form
Large Quantity Mail Orders (50 or more)
PLEASE PRINT A DUPLICATE COPY FOR YOUR RECORDS
AirMax
Breather ™
Name: ______________________________________________________________
School: _____________________________________________________________
School District: _______________________________________________________
School Address: ______________________________________________________
City: ______________________________ State: ____ Zip Code: _______________
School Phone: _______________________
Email Address: _______________________________________________________
Method of Payment (Please check only one):
P.O. Number: _____________________________________________
Name to send invoice to: ___________________________________
Check
Money Order
Please make check or money order payable to Sage Dynamics.
Ordered through (if applicable): __________________________________________
Quantity:
__________
Price (each):
$9.95
Subtotal:
__________
Tax:
__________
Texas residents only: include applicable sales tax (usually 8.25%). If tax exempt, please include
a tax exempt form.
Shipping and
Handling:
$35.00
Grand Total:
__________
Please mail payment and order form to:
Sage Dynamics
12436 FM 1960 W. #125
Houston, TX 77065
Please allow up to 4 weeks for delivery.
