Order Form
ASID Georgia Chapter
351 Peachtree Hills Avenue, Suite 504-A
Atlanta, GA   30305
Fax: 404.231.5805
 Date: ____/____/20____
 
 
 

YOUR INFORMATION SHIP TO (IF DIFFERENT):
Name
 
 Name
Street Address
 
 Street Address
City, State/Prov   Zip/Postal   Country
 
 City, State/Prov   Zip/Postal   Country
Day Time Phone
 
 Day Time Phone
YOU MAY MAIL THIS FORM TO THE ADDRESS ABOVE OR FAX ORDERS TO 404.231.5805

 Product Code  Description   Qty     Price Each           Total        
     
     
     
     
     
     
     
 
All payments must be in US funds via:
  • Personal, Business, Cashier checks
  • US Postal Service or American Express money orders
  • Visa or MasterCard
Check enclosed for $_______.____ or charge my:
 
__ Visa      __ MasterCard
 
Account Number and Expiration Date:
 
__________________________________   ____/____
 
Signature:
 
 SUBTOTAL  
Additional Shipping & Handling if desired for faster delivery. Call for quote.  
Residents of Georgia please add 8% sales tax.  
TOTAL  

Special Notes or Instructions:
 
 
 
 
 
 

Thank You for your Order!