Printable Order Form

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"Taking You Into Tomorrow"

CapTech Orders By Mail Or Fax

5414 13th St., NW Washington, DC 20011 - (202) 723-2278 - FAX (202) 882-0192
Print this form and use it for reference when calling in your order or mail or FAX it to us.

(A) Sold To: (Your name and address)

Name: ________________________________

E-mail: ________________________________

Street Address: ___________________________

________________________________

City:________________ State:___ Zip:________

Daytime Telephone:_______________________

(B) Ship To: (if different from sold to)

Name: __________________________________

Street Address: ___________________________

__________________________________

City:________________ State:___ Zip:________

Delivery Address Telephone:_____________________

Item Part #	Color #1:	Color #2:	Quantity:	Price per Item:	Total:
	_____	__________	________	___________	_________
	_____	__________	________	___________	_________
	_____	__________	________	___________	_________
	_____	__________	________	___________	_________




	_____	__________	________	___________	_________

(D) Totals, Taxes, Shipping:

Merchandise Total:________
DC Residents: add 6% Sales Tax on merchandise delivered in DC:________
Shipping (see chart):________
purchase amount:		shipping:
up to $20.00		add $4.00
$20.01-$50.00		add $6.00
$50.01-$80.00		add $8.00
$80.01-$100.00		add $10.00
TOTAL:_______

(E) Method of Payment:

___Check or money order (payable to "Capitol Technologies")
___ American Express ___ Mastercard ___ Visa

Credit card #____________________________ & exp. date:____________

Name on Credit Card (if different from above) ________________________

** Back To Ordering Page **

Call Us Toll-Free at 1-877-638-8099

Call (202)723-2278 Fax (202)882-0192

E-Mail - [email protected]

For your convenience, we accept these forms of payment:

* Checks must clear before shipping

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