USE THE PRINTER ICON IN YOUR BROWSER AND PRINT THIS FORM
Complete this order form; Please Print Plain and Mail To:
 BUX CommCo
115 Luenburg Drive
Evington, VA 24550
Make Checks or Money Orders payable to: BUX CommCo
24/7,        FAX (804) 525 7818
We Accept; DISCOVER,VISA,and MasterCard .
SHIPPING NOTICE ! FOR SHIPMENTS MADE INSIDE THE Continental USA.
For Orders 1 to 5 pounds, $7.00 Added to Total.
For Orders 5 to 15 pounds, $11.00 Added to Total.
For Orders 15 to 25 pounds, $15.00 Added to Total.
For Orders 25 to 50 pounds, $35.00 Added to Total.

Order #

Description

Qty

Each

Ext.

         
         
         
         
         
         
         
         
         
         
         
         
         
 

(VA Residents, Add sales tax)

 

$

 

 

Shipping

 

 

 

 

Total (this order) $

 

 

 

IMPORTANT; UPS will not deliver to PO Box!;   Please Complete the following information

Name:

Phone No.(         )         -     

Ship To, Address:

Today's DATE: Mo____Day_____Yr_______
City;

If Payment is by Credit Card, Please Check One
VISA__,  DISCOVER__,  MasterCard__.  

State;

Number:

Zip Code:

 Expiration date:   ___/___ (REQUIRED)

Email Address:__________________________________________Call Sign:_____________
24/7           FAX (804) 525 7818    When placing credit card orders via FAX;
Include your name as it appears on the card, and the expiration date of the card.
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