Printable Form

Printable Form

Print This Order Form and Fax or Mail

To: Nevada Technical Associates, Inc., P.O. Box 90748, Henderson, Nevada 89009. Phone: 1-702-564-2798, Fax: 1-702-558-7672. (nta@ntanet.net)

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

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Please list your email address_______________________________________________

Phone numberFax_____

I would like to purchase the following items:

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

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************************************* Shipping cost_________________

************************************* 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.