Choppy/Little Zipster order form for mailing!

CHOPPY/LITTLE ZIPSTER ORDER FORM (TEXT VERSION — Please print out & use when MAILING your order)

Order By Mail: Print out this order form, and send it along with US FUNDS check or Money Order, or credit card information to:

Vortech, Inc.
PO Box 511-W
Fallston, MD 21047 • USA

Order By Phone between 4:00pm and 8:00pm east-coast U.S. time: Have your credit card handy and call:

410-668-2757

Your e-mail address: ________________________________________________

Your Name: ______________________________________________________

Address:_________________________________________________________

City: ____________________________________________________________

State / Province: ______________ Zip / Postal Code: ______________________

Country (if not USA) _______________________________________________

Phone: _______________________________ Fax:____________________________

Please send me (prices include postage):

______ Choppy Plans @ $57/set ($75 foreign): $ ______________

_____Little Zipster Plans @ $54/set ($72 foreign): $______________

_____Choppy and Little Zipster Plans @ $95/combo ($123 foreign): $______________

SUB-TOTAL $______________

SALES TAX (Maryland residents only, add 6%)______________

All remittances must be in US FUNDS

TOTAL $ _____________

CREDIT CARD INFORMATION

(We accept VISA, MASTERCARD, AMERICAN EXPRESS & DISCOVER)

CARD TYPE (check one) _____VISA ____MASTERCARD ____AMEX ____DISCOVER

CARD NUMBER: _____________________________________________________

EXPIRATION DATE: (in the form mm/yyyy; such as, 08/2027): _______________________ SECURITY CODE (CVV): ___________

NAME APPEARING ON CARD: _________________________________________