Web Order Form        Call: (425) 836-5438                       Fax to: (425) 460-1011

Mail to:      L3 Systems, Inc.,  PO Box 2954, Redmond, WA 98073

Qty

Part #

Description

Price

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

US Shipping, Circle 1:   Fed-Ex 1-Day   Fed Ex 2-Day   Fed-Ex Gnd   Priority Mail

Intl Shipping, Circle 1:  Fed-Ex Intl Economy      Fed-EX Intl Priority           DHL International 

International requires Fed-Ex or DHL account #:________________________

Name:________________________________________________________

Company: __________________________________   PO#______________

Address:_______________________________________________________

Address:_______________________________________________________

City:__________________________________________________________

State/Province ________________________ Postal Code: ______________

Country: ______________________________________________________

Phone Number: _________________ Email Address: _______________

                                                                   (We will email Sales total & Tracking #)

Credit Card Type, Circle 1:       Visa        MC        Amex

Card #: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ - Exp Date: ___/___

                   (Visa, MC & Discover are 16 digits, Amex is 15 digits)                                    MM / YY

CVV Code: __ __ __ __ (For Visa & Mastercard, 3 digits on right of signature stripe,

for Amex, 4 digits to the upper-right of the card number.)

Name on Credit Card: ___________________________________________

Credit Card Address: _____________________________________________

Credit Card Address: _____________________________________________

Credit Card City:_______________________ State/Province _____________

Postal Code: _______________  Country: ____________________________

 

L3 Systems, Inc             PO Box 2954                       Redmond, WA 98073

Tel: (425) 836-5438      web: www.L3sys.com        Fax: (425) 460-1011