Printable Form
Print This Order Form and Fax or Mail To:
Nevada Technical Associates, Inc.,
P.O. Box 93355, Las Vegas, Nevada 89193-3355
Fax: 1-702-558-7672 or phone 1-702-564-2798.
(nta@ntanet.net)
List shipping address and billing address below. For credit card
purchases, billing address must match billing address of credit card.
Please provide all information requested.
Billing Address **********************************Shipping Address
__________________________________________|________________________________________
__________________________________________|_________________________________________
__________________________________________|_________________________________________
Email
address________________________________________________________________________
Phone number_______________________________Fax______________________________________
Name of Item-------------------------Quantity---------Unit
Cost----------------Total Cost
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
************************************************* Shipping
cost_____________
************************************************* Grand total_
_____________
Payment Method (circle one)----Check----Purchase order----Credit card
Type of card (circle one)-- Mastercard-----Visa----American Express-
--JCB
Card number________________________________________________________
Name on card_____________________________________ Expiration
date____________
Signature of card holder approving
purchase_____________________________________
(Overseas customers send fax
copy of card)
Note: We will send you an email message to confirm receipt of your
order. If shipping is by Federal Express or UPS, we will provide a
tracking number for you to track your shipment. If possible, please
list shipping cost on this order form. Our shipping
charges for shipments within the United States are given on our main
web page. For shipments outside of the United States, we can send you
a quote of shipping charges, by email.