Order Form

Keith Specialty Store: Fax: +1 724.397-2228 Voice: +1 800.705-8838

keithspecialty.com printable order form. Please print very clearly.

Name:

Date:

Shipping address:

[ ]Residential [ ]Business

Billing address (if different):

Email:

Day phone:

Fax:

Payment by: [_]VISA [_]MasterCard [_]Discover [_]American Express [_]PayPal [_]Money order [_]Check (allow 2 weeks)

Credit Card# ______________________________________ Exp. Date:_______/_________ CCV/CID __________

Name on card: _____________________________________ Signature: ___________________________________

Shipping Method: [ ]UPS Ground [ ]UPS 3-Day Select [ ]UPS 2nd day air [ ]UPS Next Day Air [ ]USPS Priority Mail
[ ]UPS Express Canada [ ]UPS Expedited Canada [ ]UPS Standard Canada (ground service) [ ]Pick up at Keith's

Qty	Item #	Description	Cost ea.	Total













Product subtotal
shipping charge*
Subtotal
Pennsylvania residents add 6% sales tax
Total

*To get shipping charges, put the items into the shopping cart and plug in you ZIP code.

Keith Specialty Store, 6791 Route 119 Hwy N, Marion Center, PA 15759
Fax: +1 724.397-2228 Voice: +1 800.705-8838