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5.7.9.6.1 Irie Pascal (Universal Edition) US$ Order Form

No. UsersUnit PriceQuantityTotal Price
    1   149.99________$_____________
    5   131.99________$_____________
   10   113.99________$_____________
   20    95.99________$_____________
   40    77.99________$_____________
  100    59.99________$_____________
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.

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