Printable Form

Print This Order Form and Fax or Mail

To: Nevada Technical Associates, Inc., P.O. Box 93355, Las Vegas, Nevada 89193. Phone: 1-702-564-2798, Fax: 1-702-558-7672 (service@nevada-technical.com)

Ship items to the address below***************Send bill to: (if different)

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Please list your email address_______________________________________________

Phone number________________________Fax_____________________________

I would like to purchase the following items:

Name of Item--------Quantity---------Unit Cost----------------Total Cost

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************************************* Grand total___________________


Payment Method (circle one)----Check/Purchase order/Credit card

(We accept the following credit cards; Visa, Mastercard, American Express or JCB card.

If paying by credit card, please list:

Card type________________________ Card number____________________

Name on card_______________________ Expiration date_______________

Signature of card holder approving purchase_________________________

Note: We will send you an email message to confirm receipt of your order. If shipping is by Federal Express or UPS, we can provide a tracking number for you to track your shipment if necessary.