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	Item	Cost
1	Manual Typewriter	$10.00**
2	Mantel Clock Dial: Gold,<br> Finish: Walnut	$10.00**
Subtotal:		$20.00
Shipping:		$10.00*
Tax:		$1.70
10.00% off sub total ($2.00):		-$2.00
Total:		$29.70

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Name: Company: Street Address 1: Street Address 2: City: State: Zip Code: Phone: Country:

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Credit Card: Purchase Order - must be
existing customer with
established Net 30 account. Card or Account Number: Expiration month: Expiration year:

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