xt/javascript" src="static/js/analytics.js"> Fax order form

Fax or Mail Order Form

Billing Information (Should be same as Credit Card info)
Name        *
Company
Address1 *
Address2
City            *
State          * Zip*
Phone       *
Email         *
How did you hear about us?

Shipping Information (If different from billing address)
Name       
Company
Address1
Address2
City           
State           Zip


American Express    Visa   MasterCard   Discover   Check or money order
Card No.   *
Exp. Date  *


Seat Cushion  Qty  1 @ $34.95 or $29.95 each for 2 or more.  

        Handles    Qty  @ $5.95  (cushion only)                         

                Pad     Qty 1 @$14.95 or $10.95 each for 4 or more 

Fabric Cover   Qty @$1.98 each (for pad only)

Price           *
Shipping    * (Listed Below)
Sub Total 
Sales Tax  8.25% Texas ship to address only.
Total          

UPS Ground  

  Standard Shipping Fees:               Expedited shipping at additional charge:     

$  1.00  -  19.99   =   $  5.50                    3 Day Select     $ 4.00

  20.00  -  39.99   =       6.00                    2 Day Air           $ 6.00

  40.00  -  59.99   =       6.50                    Next Day Air    $15.00

  60.00  -  79.99   =       7.00

  80.00  -  99.99   =       8.00                       

100.00  -119.99   =       9.00                     

120.00  -139.99   =     10.00

140.00  -159.99   =     11.00

160.00  -179.99   =     12.00

180.00  -199.99   =     13.00

200.00 -      +        =     14.00

Mail to:

UltraTech Products Inc.
9203 Hwy. 6 S., Suite #124 - #432
Houston, TX 77083

Fax: 1-281-762-8670

 

   * Indicates necessary fields                                        Home

 

       

 

Hit Counter