FAR CIRCUITS ORDERING FORM

18N640 FIELD COURT, DUNDEE, ILLINOIS 60118

SHIP TO:___________________________	Date:___________________
___________________________________	(NOTE: "SHIP TO" NAME & ADDRESS MUST BE THE SAME AS CREDIT CARD)
___________________________________	(PLEASE INCLUDE COMPLETE ADDRESS OR INCLUDE A RETURN ADDRESS LABEL)(18203)

ITEM	QTY	DESCRIPTION ( MAGAZINE, MONTH, YEAR, ARTICLE, TITLE )	AMOUNT
1	_____	_________________________________________________________________	$________
2	_____	_________________________________________________________________	$________
3	_____	_________________________________________________________________	$________
4	_____	_________________________________________________________________	$________
5	_____	_________________________________________________________________	$________
6	_____	_________________________________________________________________	$________
7	_____	_________________________________________________________________	$________
	_____	Total Number of Boards .....................................................SUBTOTAL	$________
		US & CANADA SHIPPING AND HANDING ..............$2.00 PER 4 BOARDS NOTE: LARGER BOARDS MAY REQUIRE ADDITIONAL SHIPPING CHARGES INTERNATIONAL (Excluding CANADA) ....$7.00 + $1.00 PER EACH BOARD	$________
		$3.00 CREDIT CARD SERVICE CHARGE ( CREDIT CARD ORDERS ONLY )	$________
		lllinois sales tax ( ILLINOIS RESIDENTS ADD 6.5% )................................	$________
		TOTAL	$________

Check number___________ Cash__________CREDIT CARD___________

Credit Card Company_______________( NOTE:Visa or Master Card ONLY)

Credit Card #______________________________Expir. Date____________

Home Phone Number: ___________________________________________

e-mail address__________________________________________________

Signature: _____________________________________________________

Mail, or Fax Orders to 847-836-9148 DO NOT SEND THIS FORM BY THE INTERNET