Issis Corporation of Cambria - Wisconsin SuperMall

Name	If you want your order shipped to another address, complete this section.
Address*		Name
City		Address
State Zip		City
+ + Phone ( ) -		State Zip
* Include street address, UPS will not deliver to a P.O. Box.		+ + Phone ( ) -

Model Number	Chrome, Gold Stainless, Brass	Description	Quantity	Unit Price	Total

[___] Visa [___] MasterCard

Total

Merchandise

[___]___]___]___] [___]___]___]___] [___]___]___]___] [___]___]___]___]

Add 5.5% Tax*

Expiration Date _______/_______

If Your Order Is:		Shipping Is:
Under $100		$4.00
$101 - $200		$4.50
$201 - $300		$5.25
$301 - $400		$6.00
$401 - $500		$6.75
Over $500		$7.50
All orders shipped UPS Ground Service.

< < < < Shipping

______________________________

Handling

2.00

Cardholder's Signature

Total

Payment may also be made by check or money order. We do not accept C.O.D. orders. A $25 service charge applies to any check returned NSF by your bank.

* Include a completed & signed

Tax Exemption Certificate

to claim exemption.

ISSIS Guarantee: Your satisfaction is our main concern! If you are not satisfied with your ISSIS purchase - for any reason - simply return it to us undamaged within 30 days of the date you receive it. We will replace or correct the item or refund the purchase price, whichever you wish, no questions asked. Handling, shipping and return insurance charges are not refunded.