First Name______________________________

Last Name __________________________________

Address _________________________________________

City ________________________________ State ____ Zip ____________




Select Paypal button on home page for payment www.ergomousepad.com or mail check to address below:

Qty Total
_____
X $19.95
_____
WA residents add $1.72 sales tax per each item _____
Shipping and Handling$4.95 for first item
_____
Add $.50 for each additional item
_____
Add $7.00 for FedEx overnight delivery
_____
Add $6.95 for international shipments
_____
Order total
_____

Blue, one size fits all  

Return this form to:
OZ Enterprises
449 Main Ave S #17
North Bend WA, 98045

OR fax (801) 469-3163