ORDER FORM
for Microlon Products

Name_________________________________________________________________________

Shipping address_________________________________________________________________

City________________________________________________State_________Zip____________

Phone (_______)______________________

email address _____________________________________
Optional (only for questions about your order)

Item descriptionQuantityPrice EachPrice TotalShippingShipping each additional
(20% of shipping)
1.          
2.          
3.          
4.          
5.          
6.          

Merchandise Total _________

California residents add %7.75 sales tax ________

Total Shipping _________

Total Amount enclosed _________

Send a check or money order payable to John Staudt
and mail to:

John F. Staudt
JEF Distributors
145 Paseo De Las Delicias
Redondo Beach, CA 90277
 call for questions
310-378-5334

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