insTand Order Form - Page 1

print order form, fill out, and fax to 954-788-8893

Items in italics are optional - All others are required.  Please print really big, dark, and clear. (or type).

Name as shown on credit card  
Email Address (for order confirmation)                                                                                                 
Daytime Phone #                                                              Fax #                                                                      
Billing Address
Address 1                                                                                                                         
Address 2           
City   State   Zip                  
Shipping Address (if different from billing)
Name  
Address 1             
Address 2           
City           State             Zip                           
Credit Card Information ( x   check one)
Visa  (   )            MasterCard (   )              American Express (   )              
Card #               Expiration Date                                     

 

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Order Form Page 2

Name

Item  #

               Quantity

Unit Price

Extension

CR1 Sit-down Use

 

$99.95

 

CR3 Sit or Stand

 

$119.95

 

CR5 Heavy Duty

 

$199.95

 

 

 

 

 

 

 

 

 

 

 

 

 

Order total

 

Shipping - Add 8% of Order total - $7.00 minimum chg.

 

Sub-total 

 

Florida Residents add 6% Sales Tax

 

Total to be charged to credit card

 

or - Call us at         1.877.INSTAND     (877.467.8263)