MAIL ORDERS TO: The Electronic Goldmine
P.O. Box 5408
Scottsdale, AZ 85261
Online: http://www.goldmine-elec.com
Toll Free Order Line:...........1-800-445-0697
Fax:........................................... (480) 661-8259
Customer Service Line:............. (480) 451-7454
MINIMUM ORDER: $10.00
Page#
+ SHIPPING
Stock Number
Name:_________________________________________________________________Cust#:_ _____________
Shipping to: (circle one) Home Business Company Name: _ ______________________________________
Street Address: _ __________________________________________________________________________
City: _ ___________________________________ State/Province:_ __________________________________
Zip Code: _________________________________ Daytime Phone #: (_ ________ ) _______________________
Description of Item
CHECK METHOD OF PAYMENT:
PERSONAL CHECK
CASHIER’S CHECK
AMERICAN EXPRESS
COMPANY CHECK
VISA/MASTERCARD
MONEY ORDER
CREDIT SLIP AMT.______
Check here if more space was needed for ordering and an
extra sheet of paper was used. Make sure the subtotal from
the extra sheet is indicated at right.
Credit Card Information: Credit Card Number:_____________ | ______________ | _____________ | ____________
(Circle type of card)
MASTERCARD
VISA
AMERICAN EXPRESS
Expiration Date:___________ / ____________
Cardholder Name as it Appears on Card (print):___________________________________
Billing Address:____________________________________________________________
________________________________________________________________________
The Electronic Goldmine disclaims any implied warranties of merchantability and fitness, arising in connection with the sale of any product described in this sales flyer.
In no event shall The Electronic Goldmine be liable for any claim for incidental or consequential damages arising out of in connection thereof with the manufacture,
sale, delivery or use of any product in this flyer. NOTE: Specifications, prices and availability of items are subject to change without notice. We cannot be
responsible for typographical errors.
Qty. X Unit Price
Total Price
Sub Total
Front:
Sub Total
From Extra Sheet:
AZ Residents Only Add Tax
(8.1%):
Shipping & Handling
$7.00 Min. (See Terms):
Extra Shipping Charge for
Heavier Items (See Terms):
Special RUSH Service
UPS Blue Label (See Terms):
TOTAL AMOUNT OF ORDER:
Check here if you would like a credit slip for items you have ordered that may be sold out. If you check this box, we will issue you a credit slip worth 20% more than the actual amount that is sold
out (with a maximum value of $20.00). You can return it with your next mail order and deduct the amount from your total. If you do not check this box, we will issue a refund check for any items that
may be sold out. The above only applies to orders paid by check or money order. Obviously, if your order is paid for by credit or bank card, we will charge you only for the items that are in stock.
*ORDERS RECEIVED WITHOUT SHIPPING CHARGES INCLUDED WILL BE RETURNED UNPROCESSED