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MICRO SECURITY
A Division of Underground Vaults & Storage, Inc.
NEWSPAPER ORDER FORM
BILL TO:
NAME:
COMPANY:
ADDRESS:
CITY:
STATE:
P.O.)?:
ZIP:
SHIP TO:
NAME:
COMPANY:
ADDRESS:
CITY:
STATE:
TAX EXEMPT NUMBER:
ZIP:
DATE:
QTY	ROLL H	NEWSPAPER TITLE (include city, state, month & year)			
					
					
					
					
					
					
					
					
				UNIT PRICE	TOTAL PRICE
	TOTAL ROLLS ORDERED			$42.50	
*ALL NON-INSTITUTIONAL ORDERS TO BE PREPAID SALES TAX APPLICABLE TO KANSAS RESIDENTS ONLY				AMOUNT TOTAL	
				SHIPPING-HANDLING & INSURANCE	
Allow 4-6 weeks Delivery				SUB-TOTAL	
SHIPPING, HANDLING & INSURANCE CHARGES				5>s% of Sub-Total KS SALES TAX	
MINIMUM $2.00 SHIPPING CHARGE 1-3 Rolls - Add 3% of amount total 4-9 Rolls - Add 2% of amount total 10+ Rolls - Add l}s% of amount total (Above pricing for Continental■USA - UPS)				TOTAL	
					»
			!		KDO\K sf IMAGE 3
P.O. Box 1723/Hutchinson, KS 67504-1723	(316)	662-6769