__________________________________________________
Email: __________________________________________________
City:
______________________________________________
State: _____________________________
Zip: ____________
Phone:
(_____)______-_________
Fax:
(_____)______-_________
Purchase Order #
___________________________________
Payment Enclosed* : $
_____________ or charge
*KENTUCKY RESIDENTS MUST ADD 6% SALES TAX TO THEIR ORDER
Credit Card Type:
___________________________________
Credit Card Number:
_________________________________
Expiration Date:
_____________________________________
Mail or Fax this
form to:
Innovative Productivity, Inc.
119 Rochester Drive
Louisville, KY 40214-2682
Phone: (502) 367-2186
Fax: (502) 367-4261
Please make
checks payable to: Innovative Productivity, Inc.
WE
ACCEPT ALL MAJOR CREDIT CARDS
