Midwest Technology Products

2 0 2 2 S p r i n g | S u mm e r C a t a l o g ORDER FORM

P.O. Box 3717 • Sioux City, Iowa 51102

5 Convenient Ways to Order . . . • Email orders@midwesttechnology.com

• Phone (800) 831-5904 • Fax (800) 285-7054

• Web midwesttechnology.com

• Mail P.O. Box 3717, Sioux City, IA 51102

Ship To: Attn./Dept. _____________________________________________ School (Company) ________________________________________ Street_________________________________________________ City _____________________ State ______ Zip _____________ Ordered By _ ___________________________________________ Phone No. _ ____________________________________________ Email ________________________________________________

Bill To: Purchase Order No. _ ____________________________________ School (Company) _______________________________________ Address _ _____________________________________________ City _____________________ State ______ Zip ____________ Department ___________________________________________ Date ___________ Phone No. _____________________________ Email _______________________________________________

Payment Method:

Visa

MasterCard

Discover

Certified Check

Open Account with PO No. (schools only) ___________________________________________________________________________

(V) Security Code (near signature)

Credit Card No. Expiration Date SIGNATURE _ ______________________________________________________

Special Order Instructions __________________________________________________________________________________________

_____________________________________________________________________________________________________________

Total Price

Unit Price

Qty.

Stk. No.

Mfr. No.

Size (ea., dz., etc.) & Description (color, voltage, etc.)

SIGNATURE _________________________________________________ We will back order any item temporarily out of stock & ship when stock is received. Please ship ASAP Please schedule delivery between _ ____________ & ____________ We t h a n k y o u f o r y o u r o r d e r !

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Merchandise Total Add 10% of Merchandise Total , $15.00 minimum (for Shipping, Handling & Insurance) Add Sales Tax on Merchandise Total, if applicable TOTAL

• A shipping, handling & insurance charge of 10% of total merchandise value will be added to all orders shipped within the 48 contiguous United States subject to a minimum charge of $15.00. • Actual transportation charges are prepaid & added to the invoice of all orders that ship outside of the 48 contiguous United States. These transportation charges will be added to all orders shipped to Alaska & Hawaii. Attention: Hazardous Materials including ORM-D, as defined by Federal Regulations, will not be sent to Alaska or Hawaii.