BAUERFINANCIAL - Order Form

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ORDER FORM

Please complete the following order form, and click on the Submit Form button at the bottom of the page when finished.

Customer Information:

Salutation:

First Name

Last Name

Title

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Day-Time Phone

FAX

E-mail

Order Information:

Report Institution State/
Region Price

Sub Total:

check box if Florida Taxable --> Florida Sales Tax - 7%:

Shipping-Add 5% of Subtotal:

Total Amount Due:

Billing Instructions:

Charge Credit Card
Invoice (financial institutions or D&B rated firms only)

Credit Card Information

Credit Card

Cardholder Name

Card Number no spaces

Expiration Date /

Comments:

BauerFinancial, Inc.
Gables International Plaza, 2655 LeJeune Road, Penthouse One, Coral Gables,Florida 33134
800.388.6686 FAX: 800.230.9569 Email: customerservice@bauerfinancial.com