BUX CommCO Mail or Fax Order Form

Fax: 434 525 7818
or; Mail TO:
BUX Comm
115 Luenburg Drive
Evington, VA 24550

ORDER FORM #121204

O Money Order / Check (included with mail order).
O Credit card: (Number and expiration date required) FAX or MAIL.

VISA: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Discover: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

MasterCard: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Expiration Date, (required) Month:_______ Year: ________

Order Line MONDAY thru FRIDAY 10 AM to 4 PM
Orders Only - 434 534 8873
All Orders shipped same day order received.

Name, (first-last):

_______________________________________
Street:

_______________________________________

City: ________________________State_____

ZIP: __________-______

Callsign:_________ Phone: ________________
FAX: __________________________________
e-mail: _______________________________________
Date:__________________________________
Signature:______________________________

Order No.:	Part or Model/Description	Quantity	Price Each ($)	TOTAL Price ($)













	Virginia Residents, add 5 % VA tax.			$
		Sub Total		$
	S&H
		TOTAL

Please print - fill in - fax or mail.
Important: Shipping will be added according to weight chart below. *Foreign orders will be charged according to carrier rates.
The following rates apply to order shipped inside the continental USA; except Alaska:
Orders 0 to 2 pounds, $7.90 added to total.
Orders 2 to 5 pounds, $9.90 added to total.
Orders 5 to 15 pounds, $11.90 added to total.
Orders 15 to 35 pounds, $23.90 added to total.

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