Ingram Technologies Mail In Order Form
Print this form, fill it out completely, then MAIL to:
Ingram Technologies, LLC
Rt. 2 Box 2169
Roosevelt
Utah 84066
(435)722-2597 Fax:(435)722-2599
--------- SHIPPING NAME AND ADDRESS ----------------------------------------------------
Name___________________________________________
Address________________________________________
City/State/Zip_________________________________
Country_________ Day Phone ____________________
E-Mail Address__________________________________________________
------------------------------------------- ORDER --------------------------------------
QTY ITEM CODE DESCRIPTION PRICE
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____ ____________ ______________________________________________________ __________
____ ____________ ______________________________________________________ __________
____ ____________ ______________________________________________________ __________
____ ____________ ______________________________________________________ __________
____ ____________ ______________________________________________________ __________
Subtotal _____________
Shipping** + _____________
Sales Tax* + _____________
Total _____________
**Shipping Charges:
All products are priced to include shipping to addresses within
the continental US only.
Charges for shipping outside the US will be billed at the actual shipping
and insurance rate.
*Items shipped to a Utah address require 6.25% sales tax.
(price x .0625 = total price)