Xtreme Math Games Order Form

 Item #

Description

Qty

Price

Extension

Subtotal:

Sales Tax:   7.75% for California Residents

Shipping and Handling: 10% of Subtotal ($8.50 Minimum)

Total:

Bill to:

Ship to: (if different)

Name:

Name:

Address:

City:                            State:

Zip: 

Address:

City:                            State:

Zip:

Phone #:

Phone #:

email:

email:

PO#

Credit Card Information

 Visa     Mastercard                 Expiration Date:

Card Number:

Cardholder’s Name:

Cardholders Address:(If different from above Bill to Address)

City:                              State:                       Zip:

Cardholder’s Signature:                                                            Date: