Blue Bell Design: Customer order Form

Controller, PCB, & Co-Processor Chip Order Form
Customer Information

Name

Address

City

State

Zip Code

Phone

E-Mail

Order Instructions

Please choose desired product quantities and prices from the list below. Use the extra lines for products not already listed on the form. Add Sales tax if appropriate. Total the order in the space provided.

Product Order

Product	Each	Qty	Total Price
Bare Co-Processor PCB	$14.95
Bare PCB Shipping (each)	$7.00
Co-Processor Add-on Kit	$64.95
Co-Processor Kit Shipping (each)	$10.00
Robot Co-Processor Chip	$39.95
Co-Proc Chip Shipping	$7.00


		6% Sales Tax (PA only)
		Total

Send this form with a check or money order to -

   Blue Bell Design Inc.
   PO Box 446
   Gwynedd Valley, PA 19437-0446 USA

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