Portable Advertiser Product Order Form
Step 1: Please fill out the order information as detailed as you can.
Name:
Company Name:
Phone:				Fax:
Shipping Address:   (Number, Street or Road, City, Zip or PO Box)
Email:
Step 2: Select Product and fill out the quantity.
Product Name	Color			Quantity	Amount
Brochure Holder/with Stands –  6 Pack/$7.49	White
Brochure Holder/No Stands –  8 Pack/$7.49	White
Business Card Holder–                         10 Pack /$4.95	Color			Quantity	Amount
	White
	Ivory
	Lime Green
	Lemon
	Fuchsia (Red)
	Blue
	Pink
	Orange
	Purple
	Lavender
	Variety
Variety includes:  Lemon-1, Blue-1, Fuchsia-1, Lime-Green-1, Lavender-1, Purple-1, Ivory-2 & White-2
Shipping -
Nominal Shipping will be charged to cover USPS charges (First Class or Priority) and will be added to the total amount.					Amount
California Residents add 7.75% Sales Tax
Total Amount (not including shipping)
Step 3: We accept Visa, MasterCard, Discover and American Express.
Credit Card Type:  (Circle One)
VISA                 MASTER               DISCOVER              AMEX
Credit Card No:
Exp:			3 Digit Security Code (on back of card) :
Name as It appear on Card:
Address (if different from Shipping)
Step 4: Fax this form to Missler Industries		FAX: 760 489-1197
Or
Mail to: 555 West Country Club Lane, Ste. C222  Escondido, CA 92026
Contact us by Phone:  877 816-2704