Mail In & Fax Order Form

CTI Warehouse Network

4225 101st St., Pleasant Prairie, WI 53158

Fax: 661 215 8283

Phone: 1-262-235-1521

	Item # if available	Qty	Description			Price

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Total plus shipping or taxes. Your Name: .
Billing Address:
Email Address:
Shipping Address:
Phone #:
Credit Card:	VISA Discover Card Mastercard AMEX Card Check-Money Order
Credit Card #:
Expiry Date:	Month January February March April May June July August September October November December Year 1999 2000 2001 2002 2003 2004 Signature__________________

Thank you, we appreciate your business.

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