Order Form For Capacitive Charger

 Print Out & Mail in

Price is $145 for each charger plus $15 dollars shipping.

Shipping   Address:

Phone#:________________________

Name:__________________________________________________________

Address:________________________________________________________

City, State, Zip Code_______________________________________________

Email:___________________________

      # of Chargers                                                          Price

              _____________                                                                     ___________

                                                        Total:_________

Add $5 for each additional charger.                                     Shipping Total:_________

                                                                                             Grand Total: _________

Please send Cashiers Check,

Money Order or Personal check to:

Nile Cole

548 East 9650 South

Salem,  Utah 84653