KC Providers Company

Order Form

Sold To: Ship To:

Name: ______________________________ Name: ___________________________________

Address: ____________________________ Address: _________________________________

City: _______________________________ City: ____________________________________

State: _____________Zip Code: _________ State: _______________Zip Code: ____________

Country: ____________________________ Country: _________________________________

Daytime Phone: (_____)________________ Daytime Phone: (______)____________________

Email: ______________________________

SKU No.	Qty.	Description of Item	Cost Per Item	Total Cost
anemia cell graph sickle Please send completed form and check or money order to: KC Providers Company P.O.Box 86 Denair, Calif. 95316-9501 USA			Subtotal
			Ca. State Sales Tax 7.375%
			Shipping (See Chart on Web )
			Total

Please make all check or money order payable to: KC Providers Company

All checks or money orders must clear before any items are sent. Delivery takes approxmently 7 to 10 days

Depending where shipped.

Check One of the shipping options

____ Gound Shipped _____ Priority Mail Shipped _____ International Shipped

Thank You for Shopping At: kctoycollectables.com