Blue Bell Design: Canadian Customer Order Form

Controller PCB, & Co-Processor Chip Order Form for Canadian Customers
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. Total the order in the space provided. All Amounts in US Dollars.

Product Order

Product	Each	Qty	Total Price
Bare Co-Processor PCB	$14.95
Bare PCB Shipping (each)	$10.00
Co-Processor Add-on Kit	$64.95
Co-Processor Kit Shipping (each)	$15.00
Robot Co-Processor Chip	$39.95
Co-Proc Chip Shipping	$10.00


		Total

Send this form with a check or money order to -

Blue Bell Design Inc.
Please email harry <at sign> bluebelldesign.com for the address

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