2016 Product Catalog

2 0 1 6 C a t a l o g ORDER FORM

P.O. Box 3717 • Sioux City, Iowa 51102

5 Convenient Ways to Order . . . • Email orders@midwesttechnology.com

• Phone (800) 831-5904 • Fax (800) 285-7054

• Web midwesttechnology.com

• Mail P.O. Box 3717, Sioux City, IA 51102

Ship To: Attn./Dept. ____________________________________________ School (Company) _______________________________________ Street ________________________________________________ City _____________________ State ______ Zip _____________ Ordered By____________________________________________ Phone No._____________________________________________ Email ________________________________________________

Bill To: Purchase Order No. ____________________________________ School (Company) ______________________________________ Address _____________________________________________ City _____________________ State ______ Zip ____________ Department __________________________________________ Date __________ Phone No. ____________________________ Email _______________________________________________

Payment Method:

Visa

MasterCard

Discover

Certified Check

Open Account with PO No. (schools only) __________________________________________________________________________

(V) Security Code (near signature)

Credit Card No. Expiration Date SIGNATURE ______________________________________________________

Special Order Instructions _________________________________________________________________________________________

_____________________________________________________________________________________________________________

Total Price

Unit Price

Qty.

Stk. No.

Mfr. No.

Size (ea., dz., etc.) & Description (color, voltage, etc.)

SIGNATURE ________________________________________________ We will back order any item temporarily out of stock & ship when stock is received. Please ship ASAP Please schedule delivery between ____________ & ___________ We t h a n k y o u f o r y o u r o r d e r !

Sub-total

Add Total from Additional Page(s)

Merchandise Total Add 10% of Merchandise Total , $15.00 minimum (for Shipping, Handling & Insurance) Add Sales Tax on Merchandise Total, if applicable TOTAL

• A shipping, handling & insurance charge of 10% of total merchandise value will be added to all orders shipped within the 48 contiguous United States subject to a minimum charge of $15.00. • Actual transportation charges are prepaid & added to the invoice of all orders that ship outside of the 48 contiguous United States. These transportation charges will be added to all orders shipped to Alaska & Hawaii. Attention: Hazardous Materials including ORM-D, as defined by Federal Regulations, will not be sent to Alaska or Hawaii.