DSchmidt Technologies Orderform

First, click here, read and understand my ordering rules/information
then Print out this form, mark the quantity of items you wish to order and mail or FAX it in!
We are not responsible for typographical or pricing errors!
Foreign orders shipped via Fedex may incur an additional $40 fee to obtain a Certificate of Origin!
This fee CANNOT be billed to a foreign Fedex account!

QTY                  DESCRIPTION                            Extended Price
____  DTMFLCD-C-G    Green Backlight
                       $ 89.00ea  built & tested                __________
____  DTMFLCD-C-B    Blue Backlight
                       $ 89.00ea  built & tested                __________

____  DTMF232-A        $ 43.00ea  built & tested                __________
____  DTMF232-2048-A   $ 50.00ea  built & tested                __________
____  4CH_DTMF         $109.00ea  built & tested                __________
____  8CH_DTMF         $219.00ea  built & tested                __________

____  D16-RLY          $ 39.00ea  built & tested                __________
____  DTMFRLYB-C-T     Terminal Block input
                       $ 48.00ea  built & tested                __________
____  DTMFRLYB-C-R     RCA input
                       $ 48.00ea  built & tested                __________

____  Wire Transfer - USA $10.00 fee                            __________
____  Wire Transfer - Canada  $25.00 fee                        __________
____  Wire Transfer - all other countries $35.00                __________
--------------------------------------------------------------------------                                                                              
                        Total $$ of all items marked above      __________
                 California residents, add 8.25% sales tax      __________
ALL SHIPPING PRICES BELOW ARE FOR US DESTINATIONS!
Shipping and Handling.  For 1 item, enter $7.50, each           __________
additional item, add $0.50

Foreign orders: e-mail for shipping costs.
                       TOTAL ENCLOSED (add all amounts above)   __________      
__________________________________________________________________________
Payment method: ____  Check     ____  Money Order/Cashiers Check
                ____  Visa      ____  Mastercard
 
Visa/Mastercard number  ______________________________
        Effective Date  __________ Exp Date __________
 
Name as it appears on card  _________________________________
 
Signature     _________________________________

Foreign Orders: A Certificate of Origin may be required for foreign orders
                and may result in an additional $40.00 fee (typically Israel).
                If one is required, we will contact you via Email and hold
                your order.

SHIP TO:        Name    ____________________________________

                Street1 ____________________________________

                Street2 ____________________________________

                City    ________________________State ______

                Daytime Phone(    )_____-_______ZIP ________

                E-mail address _____________________________

Special Instructions __________________________________________________

NOTE: RETURNS not due to an error on our part are subject to a 10% restocking
      fee !
_______________________________________________________________________

Mail your order to :
DSchmidt Technologies
147 Alpine Ave
Ventura, CA 93004

Or FAX it to (888) 742-7816

dschmidt ( Email Us)

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