ORDER FORM: Denver Developmental Materials, Inc.

DDM, Inc.

DENVERII.COM ORDER FORM

Denver Developmental Materials, Inc.
P.O. Box 371075
Denver, CO 80237-5075
(303) 355-4729**
1-800-419-4729
Fax* (303) 355-5622
**For phone orders, please have credit card and/or
purchase order information ready

FOR DDM USE ONLY:

DDM Customer No:________________

Order Number:____________________

Customer Purchase Order #:_______________

Date:_____________________________

Bill To: __________________________________
________________________________________
________________________________________ ________________________________________

Street Shipping Address:___________________
______________________________________
______________________________________
______________________________________

Person to be contacted if there are
questions about this order:
_________________________________________

Telephone # (____)_________________
Fax # (____)______________________
Email: ___________________________

How did you find DENVERII.COM? __Ordered Previously __DDM Provided Address __Word of Mouth __Searched Web

Catalog Number	Description of item	Unit Price	Number of Units	Line Price TOTAL
__________ __________ __________ __________ __________ __________	_______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________	______ ______ ______ ______ ______ ______	______ ______ ______ ______ ______ ______	_____________ _____________ _____________ _____________ _____________ _____________

Subtotal		____________
Colorado and Indiana Tax Exempt # ___________________	Colorado and Indiana Customers TAX(ES)	_____________
ADD 10% Shipping and Handling for Orders within contiguous USA. ALL Orders to Alaska, Hawaii, Puerto Rico, Canada and all Foreign Countries Please Call or Fax DDM for Shipping Charge		_____________

Please complete these fields for all credit card payments.
Choose credit card: () Mastercard () Visa () American Express
Card Number _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _
Expiration Month __ __ Card Holder's Name: ______________________
Expiration Year __ __ Card Holder's Signature: ________________________

Total _____________

All orders must have a purchase order or have payment included. All foreign orders must be prepaid in U.S. currency. Orders to Alaska, Hawaii, Puerto Rico, Canada and Foreign countries see further information on the ORDER page. Write DDM, Inc. for proforma invoice. Returns are only accepted within 30 days and with authorization from DDM, Inc, returned product is subject to a Restocking Charge. All rentals for one week and within contiguous USA only. Government purchase orders must be mailed if not paid by credit card. Prices subject to change without notice.
Please see http://www.denverii.com for details, pricing information, and ordering instructions.