| Prefer doing things by mail? Print this page & fax to 402-493-5100 or sendby e-mail to: Sales@IndependentTech.com INDEPENDENT TECHNOLOGIES, INC Qty Item # Description Unit Price Total Price (1) 76-100-276-B BrightID'er-Black $109.95 _______ (Add $5 /piece UPS Ground) Bill to: ______________________________________ _________________________________ Address: _______________________________ ____ ________ _______________ _____ _______ _______________________________ ____ ________ _______________ _____ _______ City/State/Zip: ___________________________________ Daytime Phone (______) __________________________ (For questions regarding your order) Ship to arrive by ________________ (Allow 10 working days to process & ship the order) Ship to [ ] Above address, ~ or Deliver Gift to: Name ______________________________ ____ ________ _______________ _____ ________ Company ______________________________ ____ ________ _______________ _____ ________ Address ______________________________ ____ ________ _______________ _____ ________ City/State/Zip___________________________________ Method of Payment Check or Money Order Enclosed (by mail) : $____________ (Make check payable to Independent Technologies, Inc.) Credit Card: American Express / MasterCard / Visa (circle one) Card Number: _______________________________________ Expires _______ / ________ Security Number -- (from the back of the card -- Last 3-digits): ___ ___ ___ Cardholder's name: ____________________________ ______________________________ Signature: _________________________________________ Please call 402-496-4700 for Express Delivery charges or delivery to Alaska, Hawaii, U.S. Territories & Foreign Countries. ~~ THANK YOU FOR YOUR ORDER ~~ Please check to see that correct quantities, product numbers and amounts are listed.Prices are subject to change without notice. DELIVERY INFORMATION: We do not ship COD. Delivery is made via UPS unlessotherwise specified (additional charges may apply, please call). Please be certain all addresses are current,complete and correct. NO P.O. BOXES PLEASE. BUSINESS GIFT ORDERS: We have discount prices for large orders. Our customerservice staff will be happy to offer help with product selection and delivery or shippingof your order. SHIPPING TIME: Most ordersare shipped within 7 days. If for any reason we are unable to ship your orderpromptly, we will notify you. DAMAGED MERCHANDISE: Please retain all packing material and call us at thenumber listed. If a package appears to be damaged at the time of delivery, pleasenotify the delivery person at that time. We will promptly arrange for replacement ofany damaged merchandise. For Christmas delivery, shipping UPS ground, we must receive your order by December 1. Ordersto Alaska, Hawaii, Puerto Rico & Canada must be received by November 20. If you are enclosing a check or money order, please make it payable to IndependentTechnologies, Inc. Use U.S. bank checks only. Do not send cash. Sorry,no CODs. IMPORTANT SHIPPING INFORMATION - ORDER SUMMARY
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