GeneralCOST Estimator Order Form

First Name: 
Last Name:
Company:
Address1:
Address2:
City:
State:
Zip:

Phone:
Fax:
Email:

Payment:
Amount:				1		$37.00		$37.00
Sales Tax (CA orders):						 $____
S&H:								 $4.50

Total								 $____

Payment By:
__Check
__Visa	No:				Exp:
__MC	No:				Exp:
__AMEX	No:				Exp:

Mail To:
CPR International, Inc.
P.O. Box 6394
Folsom, CA 95763

