Connector Protector                    Telephone an Order: 1-520-220-0340   
                       
 PO BOX 973, Sierra Vista, AZ 85636      Email: info@ConnectorProtector.com


Name: ______________________________________________________________


Company: ___________________________________________________________


Street Address: ____________________________________________________


City: ______________________________State: ______ Zip: _____________


Phone: ____________________ E-mail: ________________________________




SHIP TO:  (if different than the information above)


Name: ______________________________________________________________


Street Address: ____________________________________________________


City: ______________________________State: ______ Zip: _____________


Phone: ____________________ E-mail: ________________________________


=====================================================================
Item # | Qty | Description                      | Price Ea. | Total
=====================================================================


_______  ____  _________________________________ $________  $_______


_______  ____  _________________________________ $________  $_______


_______  ____  _________________________________ $________  $_______




                                            ORDER TOTAL:    $_________


Note:  Shipping and applicable tax will be added to the order,
       
	   

METHOD OF PAYMENT:


___Cash, Check or Money Order