NAME:

STREET:

CITY:

STATE:

PHONE NUMBER:

TOTAL PURCHASED:

TOTAL DOLLAR AMOUNT INCLUDING S&H PLUS INSURANCE:

PLEASE NOTE IN THE PURCHASE SPACE HOW MANY PANELS YOU WANT.

SHIPPING INCLUDES USPS PRIORITY SHIPPING WITH INSURANCE & DELIVERY CONFIRMATION NUMBER.

SHIPPING IS AS FOLLOWS:

1-3 PANELS PRIORITY MAIL ~ $6.50 SHIPPING

4-8 PANELS PRIORITY MAIL ~ $15.00 SHIPPING

9-15 PANELS PRIORITY MAIL ~ $17.50 SHIPPING

15-20 PANELS PRIORITY MAIL ~ $20.00 SHIPPING

PLEASE MAKE PAYMENTS TO:

JVM WEBWORKS LLC

4119 DORIS AVE.

BALTIMORE. MD

21225

PRINT THIS PAGE TO MAIL YOUR INFORMATION ALONG WITH YOUR PAYMENT