K - L O G     O R D E R     FORM To place an order by email, complete the form below and click the "submit" button. After we receive your order, a customer service representative will calculate the delivery charge and contact you by phone. At that time, you may provide your credit card information. Your order will not be processed until we receive your final approval.
	PERSON PLACING ORDER
Customer Number:
First Name:
Last Name:
Title:
Institution/Business:
Department:
Address 1:
Address 2:
City:
State:	Zip:
Name of person we should contact for approval of delivery charge:
Phone Number:
Fax Number:
Email:
Please indicate any special delivery requirements:
	BILLING ADDRESS
	Same as person placing order   Different billing address (fill in below)
First Name:
Last Name:
Title:
Institution/Business:
Department:
Address 1:
Address 2:
City:
State:	Zip:
	SHIIPPING ADDRESS
	Same as person placing order   Different shipping address (fill in below)
First Name:
Last Name:
Title:
Institution/Business:
Department:
Address 1:
Address 2:
City:
State:	Zip:
Has this order already been placed by phone, fax or email?	No     Yes       If Yes, when?
Method of payment:	American Express      Visa      MasterCard
	GSA SmartPay         Check
Have you previously ordered from K-Log?    Yes     No

ITEMS

1.

Item Number   Description   Colors/Options

Qty.   Price   $ Total   $

2.

Item Number   Description   Colors/Options

Qty.   Price   $ Total   $

3.

Item Number   Description   Colors/Options

Qty.   Price   $ Total   $

4.

Item Number   Description   Colors/Options

Qty.   Price   $ Total   $

5.

Item Number   Description   Colors/Options

Qty.   Price   $ Total   $

6.

Item Number   Description   Colors/Options

Qty.   Price   $ Total   $

7.

Item Number   Description   Colors/Options

Qty.   Price   $ Total   $

8.

Item Number   Description   Colors/Options

Qty.   Price   $ Total   $

9.

Item Number   Description   Colors/Options

Qty.   Price   $ Total   $

10.

Item Number  Description  Colors/Options

Qty.   Price $ Total $

SUB TOTAL:   $

If your organization is not tax exempt, for orders shipped to Illinois, add 6.5% SALES TAX: $

TOTAL WITHOUT DELIVERY CHARGE: $

COMMENTS: