Page 2 Order Form Page

Send personal, check money order or cashiers check payable to:  Chromi.com

USA DELIVERY ONLY, MAIL ORDERS TO:

Chromi.com
P.O. Box 805901
St. Clair Shores, MI 48080-5901

PRINT FORM AND ENCLOSE WITH PAYMENT:

Deliver Chromi to: 


Full Name:            ____________________________________________________

Street Address:     ____________________________________________________

                              _____________________________________________________

City:    ____________________________ State: __________________ Zip Code:____________


Contact Phone number (Optional): _______________________________________________

e-mail address (for confirmation of order): _________________________________________


SET includes 4 (2 Pink/2 Blue) with carry bag:


Number of Sets: ________________________ x $12.00 (US) each                $  _____________

                                                                                                                             add Ship/Handle fee    2.00


                                                             Michigan Residents add 6% sales tax (x.06) =   ____________


                                                                                                                TOTAL ENCLOSED:$___________
TAX ID:  38-3702129


*Send e-mail for special order pricing on larger shipments.   Sorry, No International Orders accepted. 




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