Abaxion Order Form

Enter Your Information:

NAME:_______________________________________________
ADDRESS:____________________________________________
____________________________________________________
____________________________________________________
PHONE:__(__________)________________________________
EMAIL:______________________________________________

Items You Are Ordering:

[ITEM#]   [DESCRIPTION]               [QTY] [PRICE]
_________ ___________________________ _____ ________
_________ ___________________________ _____ ________
_________ ___________________________ _____ ________
_________ ___________________________ _____ ________
_________ ___________________________ _____ ________
_________ ___________________________ _____ ________
_________ ___________________________ _____ ________
_________ ___________________________ _____ ________
_________ ___________________________ _____ ________
_________ ___________________________ _____ ________
                                    S/H Fee:________
(California Residents Only) 8.25% Sales Tax:________
                                      TOTAL:________

Shipping & handling rates are as follows:
(based on your order's subtotal)

=========================================================
|                                             ALL OTHER |
|   ORDER SUBTOTAL    >>>   USA      CANADA   COUNTRIES |
| -------------------      ------    ------   --------- |
| $  0.01 to $ 10.00   =   $ 4.99    $ 7.99    $13.00   |
| $ 10.01 to $ 20.00   =   $ 5.99    $ 9.99    $16.00   |
| $ 20.01 to $ 40.00   =   $ 7.99    $12.99    $25.00   |
| $ 40.01 to $ 70.00   =   $11.49    $16.49    $35.00   |
| $ 70.01 to $100.00   =   $13.49    $19.49    $45.00   |
| $100.01 to $150.00   =   $13.49    $23.49    $55.00   |
| $150.01  or  more    =   $14.99    $29.49    $65.00   |
=========================================================

* Heavy or oversize orders may require additional shipping charges.

Select Your Payment Method:(Check One)

[__] Visa            [__] Check
[__] Mastercard      [__] Money Order

Card Number:______________________________________
Expiration Date:__________________________________
CVV2# (3 digit security code):____________________
Authorized Signature:_____________________________

To Complete This Order:

MAIL THIS COMPLETED FORM TO:  [or] FAX TO:
ABAXION                            (530) 230-2719
P.O. Box 1444
Magalia, CA 95954 USA Please allow 1-4 weeks for delivery.