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  1. -----------------------------------------------------------------------------
  2.                              KwikDraw Order Form
  3.  
  4.                              The Human Interface
  5.                               902 94th St. S.E.
  6.                              Everett, WA  98208
  7.                                (206) 348-9043
  8. -----------------------------------------------------------------------------
  9.  
  10.  
  11. Name:    ____________________________________________________________________
  12.  
  13. Address: ____________________________________________________________________
  14.  
  15.          ____________________________________________________________________
  16.  
  17. City:    _____________________________ State: _________ Zip: ________________
  18.  
  19. Country: __________________________________ Phone: __________________________
  20.  
  21.  
  22. Qty: _______ x $37.95    = $______________            Shipping Rates
  23.                                                 
  24. Shipping (see rates)     = $______________             U.S. & Canada:
  25.                                                       Qty 1-3:   $3.00
  26. Charge card fee ($2.00)  = $______________            Qty 4-6:   $5.00
  27.                                                       Qty 7-10:  $7.00
  28. C.O.D. fee ($3.00)       = $______________
  29.                                                          overseas:
  30. Total                    = $______________            Qty 1-3:   $6.00
  31.                                                       Qty 4-6:  $10.00
  32.                                                       Qty 7-10: $14.00
  33. please check one:
  34.  
  35. ____  Please ship C.O.D. (U.S. only, $3.00 additional charge)
  36.  
  37. ____  Check enclosed (if you are not from the U.S. or Canada and your check
  38.       is drafted on a local bank then please convert to your local currency)
  39.  
  40. ____  Mastercard: _________________________________________ Exp: ____________
  41.  
  42. ____  Visa: _______________________________________________ Exp: ____________
  43.  
  44.  
  45. Signature: __________________________________________________________________
  46.  
  47. please allow 3 weeks for delivery