Order Form

To order, PRINT this form and mail, fax, or email it to Gregorc Associates, Inc.

GREGORC ASSOCIATES, INC.
BOX 351
COLUMBIA, CT 06237
Phone or Fax: (860) 228-0093
Email: agregorc@att.net

ORDER INFORMATION

Item Number
Description
Quantity Order
Unit Price
Total Price
         
         
         
         
         
         
SHIPPING/HANDLING CHARGES
Subtotal
 
  • For orders under $100: ADD $15.00
Sales Tax *
 
  • For orders over $100: ADD 15% of Subtotal
Shipping & Handling
 
  • For orders over $600: Add 10% of Subtotal
TOTAL
 
  • Alaska, Hawaii and Canada, ADD extra $15 shipping charge
  • 2nd Day and Next Day Air is available at extra cost.
   
* SALES TAX INFORMATION (IF APPLICABLE)
  CT Residents add 6.35%
  IN Residents add 7%
  NC Residents add current %
SPECIAL DIRECTIONS
 
 
 

SHIPPING INFORMATION (PLEASE PRINT)

Name: ___________________________________________

Title: ____________________________________________

Organization: ______________________________________

Street Address (No P.O. Boxes): ______________________

  _______________________________________________

City: ______________________ State: _____ Zip: ________

Telephone: (         ) _________________________________

E-mail Address: ___________________________________

Fax Number:  ____________________________________

Home Address: __________________________________

 _______________________________________________

City: _____________________ State: _____ Zip: ________

BILL TO: ____ Organization ____ Home

SHIP TO: ____ Organization ____ Home


THE SHIP TO ADDRESS IS:

____ Office ____ Residence


Is this your first order? ____ Yes ____ No


PAYMENT INFORMATION

Credit cards cannot be accepted.

  • All orders UNDER $25 must be prepaid by check.
  • Personal orders OVER $25 will be billed by invoice. Organizations must send an authorized Purchase Order.

  ____ Check for total amount enclosed
 (U.S. Dollars on U.S. Bank or International Money Order)

  ____ Purchase Order enclosed

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