Model Innovations, LLC Product Order Form
Please print this form, and then fill in all information below.
Please send this form and payment to:
Model Innovations, LLC
P.O. Box 2122
Salem, CT, 06420
Make checks payable to Model Innovations, LLC.
Thank you for your business!
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Date:______/_____, 20_____
Name ______________________________________________________________
Address ___________________________________________________________
City _____________________________ State _______ ZIP ____________
U.S. Orders Only Please
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Enter the quantity of each item purchased.
Quantity Item Description Cost Each Shipping (each)
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____ 1 pair: Eyeglass Wings with $6.50 $1.95
Clear Pyramex ZTek
safety glasses.
____ 1 pair: Eyeglass Wings with $6.50 $1.95
Tinted Pyramex ZTek
safety glasses.
____ Speicial Purchase - 10 pair:
Eyeglass Wings with $65.00 FREE
Clear Pyramex ZTek
safety glasses.
____ Speicial Purchase - 10 pair:
Eyeglass Wings with $65.00 FREE
Tinted Pyramex ZTek
safety glasses.
(CT residents add 6% sales tax) TAX $_________________
TOTAL: $_________________
Check No.(if paying by check) ______________________________________
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