Sign Order Form

                 Jack Mathias              
                 203 N. Pennock Lane    
                 Jupiter, FL. 33458
                 Phone  (561) 856-3776
                 E-mail Address:fuboco@futurebots.com
    ****  Please call to get a total for Signs + Shipping. Checks and Money orders made out to Jack Mathias  ****
                
           
  Name:__________________________________           Date:_______________
  
  Ship To:_______________________________
 
  _______________________________________
  
  _______________________________________    P.O.#:___________________
  
  E-Mail:____________________________     Web Site: ___________________
       
  Phone:_____________________________       Fax: ______________________         
       
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|QTY  | PART #   |           DESCRIPTION              | PRICE  | AMOUNT |
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|_____|__________|____________________________________|________|________|
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|_____|__________|____________________________________|________|________|
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|_____|__________|____________________________________|________|________|
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|_____|__________|____________________________________|________|________|
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|_____|__________|____________________________________|________|________|
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                                            Sub-Total |________|________|
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                     ( FL  residents   add 6.5%) Tax  |________|________|
                                                      |        |        |
                                            Shipping  |________|________|
                                                      |        |        |
                                       Total Balance  |________|________|
*  Sorry no Credit Cards *
 (   ) Money Order,  (  ) Company check (  ) Personal check
" All out of state checks  need a min. of 10 day clearing period."
Signs usually take 2 to 4 weeks to manufacture, depending on complexity.
If special Names or Lettering is required, make notes on back of order form.

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