Mail Order Form

IF YOU WOULD LIKE TO PLACE AN ORDER VIA MAIL OR FAX

Please fill out this form, Print it,
Mail it to us with your payment. Check, or Money Order. Or you can FAX it to us at 706.654.1300

MPTRONIX
2700 BRASELTON HIGHWAY
SUITE 10280
DACULA, GA 30019

Customer Info :

Name:
Address:
Address2:
City:	State:
ZIP:	Country:
EMAIL		For confirmation email
Phone:	Required For International Shipments

Products: - - - - -

Please add additional $20 for 2nd day air UPS delivery.

International and other shipping methods must email us first for shipping total.

For continential US Shipping, UPS cost is fixed at a flat rate,
$4.00 for orders under $10.00
$6.00 for orders $10 to $200
$10.00 for orders over $200

	$ USD
ORDER TOTAL
ADD 6% SALES TAX,(GEORGIA RESIDENTS ONLY)
SHIPPING
TOTAL