TC Life Safety : Fax Order Form

FAX ORDER FORM

Bill To / Ship To: ___Business ___Residence
For fast approval and processing, please be sure that the billing address on your order matches the billing address for your credit card. We will not ship to alternate shipping addresses not on record.

You may place your order by contacting our toll-free number at 800-837-8175. If you have any questions concerning your order, please contact us .

Name:________________________________________

Method of Payment

Address:______________________________________

__ MasterCard

__ Visa

Address 2:____________________________________

__ AMEX

__ Check *

City: __________________ State:____ Zip:__________

*Personal checks are OK; products will ship once check clears . Make checks payable to TC Life Safety. There will be a $25 returned check fee if returned from the bank.

Phone: ________________ Fax:___________________

Card Number:______________________________

License Number: _______________________________

CSC Code: ________ Exp Date: __________

License Type:________________________ State: ____

Please note that licensing information will be verified with your state's licensing agency before the order is processed. If you do not provide licensing information, you will not receive trade pricing.

Name on Card:_______________________________

Shipping Method:_____________________________
Items will ship via UPS Ground if no alternative method is indicated.

Additional Comments or Notes:

Conditions of Sale

Absolutely no refunds after 30 days. MPC-2000 modules & special orders cannot be returned.
We do not tolerate credit card fraud, which is a felony. If it is determined that an attempted order is fraudulent, we will report all information to the FBI at http://www.ifccfbi.gov.
See our Terms & Conditions for other important information.

Complete this form and either fax it (please include a copy of your resale/exemption certificate if applicable) to (800) 837-8175 or mail to:
TC Life Safety
PO Box 374
Winthrop, ME 04364

Qty	Part Number	Description	Price	Total




		Subtotal:
		Shipping: (to estimate shipping, add the products you want to your cart at www.totalcomputing.net and click the View button. Enter your zip code and freight type)
		Tax: MA (6.25%) & ME (5%), please add tax w/o resale certificate)
		Total: