| No. Users | Unit Price | Quantity | Total Price |
|---|---|---|---|
| 1 | 79.99 | ________ | $_____________ |
| 5 | 69.99 | ________ | $_____________ |
| 10 | 59.99 | ________ | $_____________ |
| 20 | 49.99 | ________ | $_____________ |
| 40 | 39.99 | ________ | $_____________ |
| 100 | 29.99 | ________ | $_____________ |
| Shipping | |||
| & Handling | 5.00 | $_____________ | |
| TOTAL | $_____________ |
[ ] Check/Money Order enclosed [ ] Charge credit card
[ ] AmEx [ ] MasterCard [ ] Visa
Account #:__________________________________________________
Expiration Date:____________________________________________
Name:_______________________________________________________
Address:____________________________________________________
City/State/Province:________________________________________
Country/Postal Code:________________________________________
Telephone:_______________________________________ [optional]
Email Address:___________________________________ [optional]
How did you hear about Irie Pascal?_________________________
_________________________________________________ [optional]
[ ] Tick this box to join the Irie Pascal mailing list.Please do not send cash. Make checks or money orders payable to Irie Tools. All prices are quoted in US$ and are guaranteed until December 31, 2005. Please allow two to four weeks for delivery. If you fill in your email address you will be notified by email when your order is shipped.