Check-Six.com Order Form

CHECK-SIX Order Form
Make sure you print your e-mail address VERY clearly.
Thank you.

only via

To place an order, print this form out and complete. Then mail or FAX it to Check-Six.
Check product page for shipping charges. Prices on the Web page are current, but are subject to change.

Name: _______________________________________________________________

Address: _____________________________________________________________

City: ________________ State: Zip:_

Home Phone: ___ Work Phone:

E-mail address (required)______________________________________________

Stock Number	Product Description	QTY	Price	Total









Sub Total
California Residents add 8.25% sales tax
Shipping within USA Only ($15 per display, $5 per patch / item - Shipped via US Priority Mail- Is Insured - NO International orders)
TOTAL (Personal Checks Must Clear Before Order Ships - May Take Up to Two Weeks.)

Send this completed form plus a check or money order to:
Check-Six
PO Box 1797
Martinez, CA 94553