Phoenix Graphix 2012 : Page 191

ORDER FORM Send To: Phoenix Graphix Inc. 400 S. 79th St. Chandler, AZ 85226 BUY FACTORY DIRECT OEM LICENSED MANUFACTURER E-mail: frontdesk@PhoenixGraphix.com +Int: 480.941.4550 Fax: 480.345.8680 ORDER BY NAME: ADDRESS: CITY: PHONE: HOW DID YOU HEAR ABOUT US ?: VEHICLE INFO COMPANY: YEAR: MAKE: [Unable To Ship P.O. Box] STATE: ZIP: E-MAIL: COUNTRY: MODEL: COLOR: ENGINE SIZE: DON’T FORGET TO SHIP TO SAME AS ABOVE NAME: ADDRESS: CITY: PHONE: STATE: COMPANY: [Unable To Ship P.O. Box] ORDER Stage 1 Surface Cleaner -[4 FL.OZ] Stage 2 ZIP: E-MAIL: COUNTRY: Application Gel -[16 FL.OZ] Stage 3 UV Protectant & Conditioner -[8 FL.OZ] BEST 99 All VALUE For $ Part#..... APP3X 3 9 QTY PART# -COLOR CODE DESCRIPTION UNIT PRICE TOTAL PAYMENT METHOD CASHIERS CHECK -MONEY ORDER PERSONAL CHECK -COMPANY CHECK C.O.D. (USA ONLY) SUBTOTAL SHIPPING & HANDLING USA ADD 10% ($12.50 Min.) SHIPPING & HANDLING CANADA ADD 10% ($32.00 Min.) AZ RESIDENTS ADD 8.8% TAX Or AZ TAX RESALE # *EXPRESS SHIPPING, INT’L &/OR C.O.D. CHARGE CARD NUMBERS EXPIRATION DATE: DISCOUNT COUPON(S) RUSH SHIPPING $2.99 SIGNATURE: PRINTED NAME: *RETURN POLICY* After 30 Days a 15% Restocking Fee Will Be Applied (Less Shipping Cost) SECURITY CODE (REQUIRED) TOTAL *EXPRESS & INTERNATIONAL RATES: NEXT DAY ADD ..................... $35 2nd BUSINESS DAY ADD ..... $20 (AK, HI, PR, req. 2 Day Shipping) 3rd BUSINESS DAY ADD ...... $15 INTERNATIONAL ADD .......... $85 C.O.D. ORDERS ADD ........... $16 (C.O.D. Available In USA Only) Security Code is a 3 or 4 Digit No. On Front Or Back Of Your Credit Card SHIPPING & HANDLING IS NON-REFUNDABLE CUT HERE

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