PE Central Challenge
Pin Purchase Order Form

Make Checks Paybable to PE Technologies


Ship to (your name): ____________________________________ Date: ___________

School/Organization Name: _______________________________________________

Street: _______________________________________________________________

City: _______________________________ State: ___________ Zip: _____________

Phone: ________________ Fax: ________________ E-mail: ____________________

ITEM

QUANTITY

ITEM COST

TOTAL

Gold Pins  
X $1.35
 =
Silver Pins  
X $1.35
 =
Bronze Pins  
X $1.35
 =
   

Sub Total:

 =
   

USA Shipping Cost
$6.00 on orders 0-$50
$7.50 on orders $50.01-100
$9.00 on orders $100.01+

Int'l Shipping
Add $25.00 on orders 0-$50
$30.00 on orders $50.01-100
$35.00 on orders $100.01+

 =
   

Virginia Residents Only
Add 5% Sales Tax
(Total X .05)

 =
   

TOTAL:

 =

Make Checks and Purchase Orders payable to: PE Technologies
(Mail to: PE Central, PO Box 10262, Blacksburg, VA 24062; Fax: 540-301-0112)