Quantum Leap Inc.
Mail/Fax Order Form

Instructions: (You can either fill in the form and then print it, or print it and fill it in by hand.)

1. Fill in your "Ship to" information.
2. Fill in the Quantity, Part #, Description, Price, and Row Total for each product you want to order.
3. Fill in the Subtotal and tax.
4. Add shipping charges: $5 for up to $50 orders, $7.50 for $50-200 orders, $10 for $200+ orders.
5. Calculate the Total.
6. Make out a check or Money Order to Quantum Leap, Inc., or fill in your Visa or Mastercard # and expiration date.

7. Mail or FAX this order form to:
   

   Quantum Leap, Inc.
   1880 N 800 West
   Orem UT 84057
   FAX 801-226-6200