ORDER FORM

SKA "Pro Chips" For Your Chart Plotter
It is prefered that the form be filled out on-line by typing in the text fields and then printing, but there is also
the option to print this form blank and fill it in neatly by hand. You may mail or fax the form to SKA.
FAX: 904-819-0331 MAIL: SKA, 15 Garnett Ave, St Augustine, FL 32084
NAME:
First Name: Last Name:
BILLING ADDRESS:
Street / PO Box: City:
State: Zip:
Phone: Cell:
Email:
SHIPPING ADDRESS:
Street: City:
State: Zip:
ORDER INFORMATION:
Choose Chip from List
Qty
Choose Brand & Model GPS Plotter
Price Each
Total
$275.00
  Sub-Total
  Shipping & Handling  - UPS Charge Plus $2.00 Handling.
  Florida Sales Tax
  Total
PAYMENT INFORMATION:
Total Payment Amount From Above:
$
  Check Enclosed    Check Number:  
Visa, Master Card, American Express, Discover Card (Include all Digits on Credit Card)
Card Number:    Sec. Code:    Exp:  
Print Name on Card:  

Signature:  X_____________________________

If paying by check, call first for shipping estimate 904-819-0360