ORDER FORM:
Date _____________________
Last Name____________________________ First Name ________________________________MI
Mailing Address
City and State _____________________________________________Zip +4
Country of Citizenship______________________________ Home Telephone__________________________
Work Telephone______________________________ Fax Number ___________________________________
E-mail Address_____________________________________________________________________________
PAYMENT: Check or Money Order (in US Funds)
Visa Master Card Discover American Express
Cardholder Name (please print):________________________________________________________________
Card #: - - -
Expiration Date: _________________CSV#___________ Phone #: ________________________________
Cardholder Signature: ______________________________________________________________________
Mail To: NRHA Phone: 405-946-7400
3021 W. Reno Fax: 405-946-8425
Oklahoma City, OK 73107-5302 Website: nrha.com
Revised 2012 Printed in the U.S.A.
BIT GAUGE
_____ $20.00 + Shipping (OK residents add $1.68 sales tax)
_____ Shipping within the U.S. (Add $5.95 for 1 Item; $9.95 for 2 Items)
_____ Shipping to Canada (Add $10.95 for 1 Item; $12.95 for 2 Items)
_____ International and Express Shipping (Add $11.95 for 1 Item; $14.95 for 2 Items)
______ TOTAL
click to sign
signature
click to edit