Please print out and Fax to: 301-668-5019 or Mail To: SESTO-SENSO, 1206 Markel Circle, Frederick, Maryland, 21702.

Please Print Clearly:

E-Mail Address:_____________________________

Name:_____________________________________

Bill To Address:______________________________

___________________________________________

Ship To Address:_____________________________

__________________________________________

Phone Number:_______________________________

Payment (Check One): [ ] Check/Money Order [ ] Visa[ ] Amex [ ] Master card [ ] Discover [ ]

Account #:___________________________________

Expiration Date:_______________________________

Signature:____________________________________

Comments:___________________________________

_____________________________________________

Quantity:____Description:________________________

Quantity:____Description:________________________

Quantity:____Description:________________________

Quantity:____Description:_________________________

Quantity:____Description:_________________________

Subtotal:____________________

Shipping:____________________ (See Below)

Tax:___________(MD residents add 5% sales tax)

Total:__________

 

Shipping Charges

$0.00 to $50.00 = $4.95 s&h

$50.01 - over = $6.50 s&h

Shipping Upgrades Available:

Second Day Air: Add $10.55 to ground rate

Next Day Air: Add $19.05 to ground rate

(available in continental US ONLY)

**International orders: shipping will be calculated according to destination**