Order Form

Order Number:

Name (please print)_________________________________________________________

Address ____________________________________________________________________

City ______________________ St./Prov. ________________ Zip Code ____________

Country (if not USA) __________________ Phone _____________________________

Email address __________________________________

Quantity	Item Number	Description	Price



		Subtotal:
		Shipping/Handling:
		(Michigan residents MUST add correct sales tax) Tax:
		Total:

SHIPPING/HANDLING CHARGES:

[] USA: $5 each

[] Canada & Mexico: $6 each

[] All other countries: $8 each

[] I would like save shipping cost and have it emailed to the address above.

Note: Payment must be in U.S. dollars, drawn from a U.S. bank.

Please do not send cash!

Payment type:

[] Check

[] Money Order

Make checks payable to "Micronet Technologies".

Phone: 616-583-1990 Fax: 616-583-1992

All prices subject to change without notice. All items subject to availability.

Thank you!