Order Form And Price List Merchandise

____________________________________________________________________________

Mail To: Auralex Acoustics, Inc.

8851 North Hague Road

Indianapolis IN 46256-1284

Or Fax To: (317) 842-2760

Questions?: Call (317) 842-2600

This order form constitutes a legal, binding agreement to purchase. All sales are final regardless of

method of payment. Customer pays all collection fees & attorneys costs and in event of dispute, the

courts of the State of Indiana shall have jurisdiction. By signing above customer agrees to all terms &

conditions stated on this document, in the Auralex catalog & as discussed with representatives of Au-

ralex. If purchasing for a group, signer vouches that authorization exists to make this purchase. Seller

disclaims all liability associated with this sale. Buyer determines fitness for his or her intended usages.

ITEM DESCRIPTION & SIZEQTY. COLOR PRICE EA.

(IN. 5%)

Shipping

Grand Total

Name ____________________________________ Co. Name ___________________________________

Shipping Address _________________________________________________________________________

City ________________________________________ State _____ Zip _____________________________

Phone ___________________________ Ext. _____ Fax ________________________________________

Billing Address (if different) ________________________________________________________________

City ________________________________________ State _____ Zip _____________________________

Have you received our catalog? Yes No Is this order to be drop shipped? Yes No

If yes, to whom? _______________________________________________________________________

_______________________________________________________________________

* If ordering for a company & it is tax exempt, include a copy of the firm’s tax certificate for our files.

EXT. PRICE

PAYMENT INFORMATION

Purchase Order (fax a copy; prior approval must be granted)

Payment In Advance (personal & co. checks held for clearance)

MasterCard Visa Discover American Express

Expir. Date On Card ___________ Card # __________________________________________________________

Printed Name On Card (very important!) _________________________________________________________

Signature Of Order Placer (Even If Not Paying By Credit Card) _____________________________________

See Price List For Exact Prices & Freight Charges

Today’s Date ____________________

(Give name, address,

city, state, zip and

phone number of drop

shippee)

Order Form

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