PLEASE PRINT OUT THIS FORM FOR YOUR ORDER

Copernican Technologies, Incorporated Product Order Form

Mail to:

Copernican Technologies, Inc.
Attention: Sales
P.O. Box 8527
Santa Cruz, CA 95061-8527 U.S.A.

Name:    ______________________________________

 

Address: ______________________________________

 

City:    ______________________________________

 

State:   _____ ZIP: __________________

 

Country: ______________________________________

 

Email:   ______________________________________

 

Phone:   ______________________________________

 

FAX:     ______________________________________

PAYMENT METHOD

[ ] Check (US Funds Drawn on a US Bank)
Make payable to  Copernican Technologies, Inc.

Signature  ________________________  Exp. Date  _____________

 

Product

Quantity

Each

Total

Boswell® 4.0.1

 

$99.95

 

 

Sub Total

 

California State Residents Please Add 8.25% Sales Tax

Tax:

 

U.S. Shipping and Handling*

S&H:

$4.95

 

Total:

 

*International customers should Email sales@boswell.com for shipping prices.