Romar Order Form

471 Burton Street
Beloit, WI 53511 USA
Phone: 608-299-1615
Fax: 608-299-1827

Simply Print And Fill Out This Order Form,
Mail To The Above Address,
Or Fax Us At:(608)299-1827

Or Call 1-608-299-1615 (Mon. - Fri., 8 AM to 5 PM, CST)

Minimum Order = $20.00 plus Shipping & Handling

	SUBTOTAL
	5% Sales Tax (WI Residents Only)
* Standard Ground shipping to U.S. destinations only. Please call for a quote on international or air shipments	Shipping & Handling	$7.00
	TOTAL

SHIP TO:		Payment Method:
__________________________ Name		Check/Money Order (Please Make Payable To Romar Co.)
__________________________ Address		Amount Enclosed: $_____________
__________________________ Apt.No.		Charge To:Visa Master Card
__________________________ City, State, Zip		_____________________________ Credit Card Number
		_____________________________ Expiration Date
		_____________________________ Signature
		(______)______________________ Daytime Phone Number