ORDER FORM

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Send or Fax this Order Form to:
California Technologies
1315 Solano Street, Suite A
Corning, CA 96021
(530) 824-9133 - fax 824-9133
E-mail - webmaster@catechnologies.com

Date:_________________________________________________

Name:________________________________________________

Address:______________________________________________

City/State/Zip:_________________________________________

Phone:_______________________________________________

E-mail:_______________________________________________


ITEM/DESCRIPTION                                                                         PRICE                         SHIPPING
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TOTAL FOR GOODS:___________________________________

(CA Residents Only) SALES TAX (7.25%):__________________

SHIPPING:____________________________________________

TOTAL:_______________________________________________

TERMS: Money Order, Cashier's Check, Credit Card
Personal Check (allow 10 days for bank clearance)
Please make check or money order payable to: California Technologies

Discover Card Account No.:______________________________________________

MasterCard Account No.:________________________________________________

Visa Card Account No.:__________________________________________________

Expiration Date:________________________________________________________

Cardholder Name:______________________________________________________

Cardholder Signature____________________________________________________