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Billing Information:
Name:_______________________________
Address:______________________________
____________________________________
City:_____________State:______Zip:_______
Phone:________________________________
Shipping Information: (if different)
Name:_______________________________
Address:______________________________
____________________________________
City:_____________State:______Zip:_______
Phone:________________________________
PRODUCT
 
 
CODE
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
QTY
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PRICE
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
TOTAL PRICE
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
METHOD OF PAYMENT
  

(Payable to High Touch)

HighTouch
MSC 333, 6677 West Colfax Avenue
Denver, Colorado 80214-1896

Credit Card Money Order Check

Credit Card Information:
Sub Total $
 
Sales Tax (CO Resident add 3.5%) $
Shipping & Handling (7%) $
TOTAL $
____________
 
____________
____________
____________

Visa MasterCard Discover AmericanExpress

Card Number______________________ Exp. Date _______

Name on Card ____________________________________

Signature ________________________________________

  

Please make copy for your records.