Web Order Form Call: (425) 836-5438 Fax to: (425) 460-1011

Mail to: L3 Systems, Inc., PO Box 2954, Redmond, WA 98073

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Part #

Description

Price

Total

US Shipping, Circle 1: Fed-Ex 1^-Day Fed Ex 2-Day Fed-Ex Gnd Priority Mail

Intl Shipping, Circle 1: Fed-Ex Intl Economy Fed-EX Intl Priority DHL International

International requires Fed-Ex or DHL account #:________________________

Name:________________________________________________________

Company: __________________________________ PO#______________

Address:_______________________________________________________

Address:_______________________________________________________

City:__________________________________________________________

State/Province ________________________ Postal Code: ______________

Country: ______________________________________________________

Phone Number: _________________ Email Address: _______________

(We will email Sales total & Tracking #)

Credit Card Type, Circle 1: Visa MC Amex

Card #: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ - Exp Date: ___/___

(Visa, MC & Discover are 16 digits, Amex is 15 digits) MM / YY

CVV Code: __ __ __ __ (For Visa & Mastercard, 3 digits on right of signature stripe,

for Amex, 4 digits to the upper-right of the card number.)

Name on Credit Card: ___________________________________________

Credit Card Address: _____________________________________________

Credit Card Address: _____________________________________________

Credit Card City:_______________________ State/Province _____________

Postal Code: _______________ Country: ____________________________

L3 Systems, Inc PO Box 2954 Redmond, WA 98073

Tel: (425) 836-5438 web: www.L3sys.com Fax: (425) 460-1011