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PLEASE PRINT OUT THIS FORM FOR YOUR ORDER
Copernican Technologies, Incorporated Product Order Form
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Mail to:
Copernican Technologies, Inc.
Attention: Sales
P.O. Box 1212
Palo Alto, CA 94302-1212 U.S.A.
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Name: ______________________________________
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Address: ______________________________________
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City: ______________________________________
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State: _____ ZIP: __________________
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Country: ______________________________________
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Email: ______________________________________
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Phone: ______________________________________
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FAX: ______________________________________
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PAYMENT METHOD
[ ] Check (US Funds Drawn on a US Bank)
Make payable to Copernican Technologies, Inc.
Signature ________________________ Exp. Date _____________
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Product
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Quantity
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Each
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Total
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Boswell® 4.0.1
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$99.95
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Sub Total
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California State Residents Please Add 8.25% Sales Tax
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Tax:
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U.S. Shipping and Handling*
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S&H:
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$4.95
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Total:
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*International customers should Email sales@boswell.com for shipping prices.
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