O r d e r F o r m

Print this form and send by mail. Please print clearly. Credit card orders accepted online:

www.spycamsupply.com

QUANITY MODEL# PRODUCT DESCRIPTION PRICE EA. TOTAL # $ $ # $ $ # $ $ # $ $ # $ $ # $ $ # $ $ # $ $ # $ $ # $ $ # $ $ # $ $ # $ $ # $ $ # $ $ # $ $ # $ $ # $ $ # $ $

Subtotal	_____________
Please add $10.00 for S&H + $2.00 on ea. additional item. ie: 4 items = $16.00	_____________
Total	_____________

Name____________________________________________

Address__________________________________________

City____________________State______Zip____________

Phone(______)____________________________________

Email______________________@____________________

Send Order to: PacWest Distributing 1431 1/2 Harrison Ave Blaine, WA 98230

Method of Payment: (Make checks payable to: PacWest Distributing and allow 10 days for personal checks to clear) [___]Money Order__[___]Check___[___]Cashiers Check

Note: It is the responsibility of the buyer and not PacWest Dist. to ascertain and obey all applicable laws in regard to the possession and use of our products. Absolutely no sales to minors. By placing an order, the buyer represents that all products purchased will be used in a lawful manner and that they are of legal age