WinLegal.com 5603 Riley Shawnee Mission, KS 66202-1249	Order Form	Fax: 877-710-0170 sales@winlegal.com
Please complete the following info., print this form, then fax or mail this form with payment.

Name:				Address:
Company:				City:
Phone:				State:
Fax:				Postal Code:
E-Mail:

Enter Kit Information and Pricing Below

Kit Title		Cost per Kit	$	Subtotal	$
Kit Title		Cost per Kit	$	Subtotal	$
Kit Title		Cost per Kit	$	Subtotal	$
Kit Title		Cost per Kit	$	Subtotal	$
Kit Title		Cost per Kit	$	Subtotal	$
Kit Title		Cost per Kit	$	Subtotal	$
Shipping & Handling: 0 to $25 = $4.95 | 26 to $40 = $6.95 | 41 to $60 = $7.95 | 61 to $80 = $8.95 | 81 to $100 = $9.95 | 100 to $125 = $12.95 .				Shipping	$
				Total	$

Payment Method
Credit Card	* Check	Postal Money Order

WinLegal.com accepts Visa, & MasterCard. If paying by credit card, please make sure the address above is the same as your credit card billing address.Credit Cards will be billed as:"Richard Gibisas, ENT."
* Make Checks payable to: "Richard Gibisas, ENT".
Credit Card Number		Exp. Date
Cardholder Name		Card Type
Signature (for credit card orders):
*Checks must Clear before Kits will be Shipped!

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