Purchasing Order & Credit Card Authorization Form

If you wish to charge the amount of your advance orders to your credit card account, please complete the information requested below and fax this form to (909)718-0998 Lasermate Group, Inc..
         Purchasing Order             Date (mm-dd-yy):_____ - _____ - ______

QTY          Model No.                 Brief Description                        Unit price            Amount
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(International shipping: please ask for the cost of freight)
(Shipping 1lb in California only: 1 week $8.00; 2nd Day $13.00; Next Day $22.00)       SALES  _____________
(Shipping 1lb in USA: 1 week $10.00; 2nd Day $22.00; Next Day $35.00)                  FREIGHT  _____________
                                     (9.00 % sales tax for California residents)        SALES TAX  _____________

Note: Please add $4.00 more for residential address, $5.00 for signature required.  

                                                                                                                 TOTAL   _______________


Credit Card Authorization Form

Charge to: ____MasterCard ____Visa  ____American Express   Total Amount: USD____________

Card No. : |___|___|___-___|___|___|___-___|___|___|___-___|___|___|___|___|

Expiration Date:|___|___|___|___|         3-Digit Security Code (on the back of card): |___|___|___|

American Express 4-Digit Security Code (on the front of card): |___|___|___|___|

Cardholder's Name:______________________________________________________

Cardholder's Signature:___________________________________________________

Phone Number: ________________________     Fax Number: ______________________

Cardholder Address:_________________________________________________

                                      _________________________________________________

Company Name: _______________________________________________

Shipping Address: _______________________________________________

                                 _______________________________________________

E-mail address:   ________________________________________________