You can order Shimo Kobo products using one of these three methods:

1. Telephoning 606-787-0022

2. Printing this order form and mailing it, with payment, to

   Shimo Kobo
   563 Via San Miguel
   Liberty, KY 42539
   USA
   

3. Printing this order form and faxing it to 606-787-0059.

NOTE:

On credit card orders, if your billing address for the credit card is different from your shipping address you must provide your billing address. We verify all billing addresses prior to shipping, for your protection.

You may type in your information, then print and send to Shimo Kobo.
Before printing we suggest you set your browser font size to: 9 POINT.

SHIP TO ADDRESS:

First Name:		Middle:		Last Name:
Company:
Street:		Suite:
City:		State:		Postal Code:
Country:
Work Phone:
Home Phone:
Fax:
E-Mail:
CC Billing:	Same as ship to address.
First Name:		Middle:		Last Name:
Company:
Street:		Suite:
City:		State:		Postal Code:
Comments:

Item No.:	Description of Product:	Unit Price:	Quantity:	Total Price:
Product Total
Sales Tax (KY Only, 6%)
Shipping (Minimum 7.75) (For lamp, see table below)
Total Amount Due

Method of payment:		Personal or Company Check (Held 6-8 weeks to clear.)
		Visa
		MasterCard
		American Express
		Discover
		Casher's Check or Money Order (US$ only)

NOTE: To avoid fraud we verify all credit card billing addresses with the issuing bank. By supplying this information it will help facilitate us in getting your order out sooner. If you do not supply your billing information we will not fill your order.

Credit Card Number:
Expiration Date:
Security Code (For VISA / MC Last 3 digits on card near the signature area): (For AMX 4 digits on the front of the card): (For Discover Card there is NO Code yet):

NOTE: Credit card payment will be charged by MFI.
I authorize MFI to charge my credit card per the above order.

Card Holder's Signature:____________________________________________________________