Dental Handpiece Repair Business- Order Form

ORDER FORM

Please print this order form or copy/paste it to a new message in your email program.

Then simply mail it, email it, or fax it . . .

Mail: Bill Sjostrom, WGSC Publications 9629 Ripple Creek Drive Moreno Valley, CA 92557-1821

Email: BillSjostrom@wgsc.com

Fax: 951.924.8431

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Please Send TO:

Name___________________________________________________

Address_________________________________________________

City__________________________ State_______ Zip____________

Email Address____________________________________________

How Did You Find Us? ____________________________________

[ ] Dental Handpiece Repair Business - Plan A $99.95 plus $10 s/h ($109.95)
CA residents only add $7.75 tax ($117.70).

[ ] Dental Handpiece Repair Business - Plan $897 plus $15 s/h ($912)
CA residents only add $70.68 tax ($982.68).

Amount Enclosed _____________

[ ] VISA [ ] MasterCard [ ] Money Order [ ] Check

Card Number ________________________________________________

Expiration Date ____________

Signature ____________________________________________________

To receive Priority handling send money order or credit card payment.

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Note: All orders from outside continental U.S. please pay by money order, U.S. Funds, and
add $5 to regular S&H charges. Sorry no C.O.D's.

Please send WGSC your comments.