Order by Fax

1-585-663-9363

Order By Phone

1-866-204-1382

Order by Mail
Bar Code Scanners Discount
70 Susan Lane, Suite 4
Rochester, N.Y. 14616


Phone: _______________________  email: __________________________

Bill To/Ship To:

Name: _________________________________________________________________________

Street: _________________________________________________________________________

City: ______________________________________________ State: _________Zip:___________

Quantity

Part#

Description

Comments

Unit Price

Ext Price

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Purchase

    $

Domestic Shipping

    $      

Sales Tax (8% New York Residents)

    $

Total Order

    $

Method of Payment

VISA___  MasterCard___  Discover___  American Express___  Money Order (Enclosed)___

Card Number:

 

 

 

 

-

 

 

 

 

-

 

 

 

 

-

 

 

 

 

Experation:

 

 

-

 

 

 

Signature: ____________________________________________________Date: _________