Pitrone and Associates, Ticket Racks, Call: 215.956.9797

P.O. Box 711 Hatboro, PA 19040

"Celebrating Our 18th Year "

Phone: 215-956-9797 *Office Hours* Fax: 215-674-9338

*Ticket Racks Order Form* Print and fax or mail this form
Model								Price	Quantity Ordered	Total Price
(Specifications on ticket rack page)
Rack # 1	.	.	.	.	.		.	Price $ 299.00	.	.
Rack # 2	.	.	.	.	.		.	Price $ 319.00	.	.
Shipping Costs for continental U.S.A shipments.	*****	*****	*****	*****	*****		*****	$34.00 per rack	.	.
Sales Tax (PA shipments only) add 6%	*****	*****	*****	*****	*****		*****	Sales Tax PA Only	.	.
Grand Total	*****	*****	*****	*****	*****		*****	Total	.	.

Date:__________Billing Information

Name:__________________________________

Company:_______________________________

Address:________________________________

Address:________________________________

City:________________________State:______

Country:___________ZipCode:_____________

Phone Number:__________________________

Fax Number:____________________________

E-Mail:________________________________

Shipping Information

Name:__________________________________

Company:_______________________________

Address:________________________________

Address:________________________________

City:________________________State:______

Country:___________ZipCode:_____________

Phone Number:__________________________

Fax Number:____________________________

E-Mail:________________________________

Charge to my: [MasterCard]____[Visa]____[Discover-Novus]____[American Express]______

Cardholder Name:________________________________________

Card Number:____________________________________________

Exp Date:_________

Signature:_____________________________Todays Date:________

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