order form

	Poc-it Order Form
	After filling this form out please fax or mail it to: Microtools Inc.
	Fax #: 860-651-0019
	Address: P.O. Box 624 Simsbury CT 06070
	Product Order Information:
	Please select which items you are ordering and fill in the quantity
		Item		#		X	Price	Subtotal
		Poc-it				X	$395
		Poc-it with Remote Control option				X	$495
		Poc-it with PowerCycler option				X	$795
		Poc-it with PowerCycler and Remote Control option				X	$895
		Banana jack mini-clips				X	$20
	Subtotal
	Tax (only for CT)
	Shipping
	Total


Where did you hear about Poc-it? (Please spread the word)


	Shipping Options
	Handling Only (tell us how you want it shipped and your UPS or FedEx account number)		$5.00
	USPS Priority		$10.00
	FedEx 3 Day Express Saver		$30.00
	FedEx 2 Day		$35.00
	FedEx Standard Overnight		$50.00
	FedEx Priority Overnight		$55.00
	FedEx Ground		$30.00
	FedEx International Economy		$85.00
	For each additional Poc-it add		$5.00


	Billing Information
	Name
	Company
	E-mail address
	Phone number				include area code or country code (if outside US)
	Fax
	Street address 1
	Street address 2
	City
	State/Province
	Postal Code
	Country

	Shipping Information
	Name
	Company
	Street address 1						if different from billing address
	Street address 2
	City
	State/Province
	Postal Code
	Country

	Payment Method
		Check					Credit Card
	If paying by credit card please fill out the following information
		Mastercard
		Visa				American Express

	Card #
	Expiration Date						mm/yy
	Verification Value						This Number is not embossed. American Express is 4 digits (located on front of card), for all other cards it is 3 digits (normally on the signature strip).