ORDER FORM FOR NFM-6C TIME ALIGN® NEARFIELD MONITOR
PLEASE PRINT AND FILL OUT FORM
MAKE CHECK TO: E M LONG
MAIL FORM AND CHECK TO:
ALEMBIC, INC.
3005 WILJAN COURT
SANTA ROSA, CA 95407
I WOULD LIKE TO PURCHASE
THE NFM-6C TIME ALIGN® NEARFIELD MONITOR
AT $695.00 PLUS 50.00 EACH SHIPPING & HANDLING
NFM-6C WILL BE SHIPPED UPS GROUND
NO POST OFFICE BOXES!
NUMBER OF NFM-6C_____
CHECK AMOUNT ENCLOSED $_______
NAME_________________________________
ADDRESS______________________________
CITY__________________STATE___ZIP_____
PHONE________________
EMAIL_________________
3C