FAX / Mail Order Form

Palisades Research
869 Via De La Paz
Pacific Palisades, CA 90272
1-(310)459-7528 tel     /    1-(310)459-9054 fax

A. NAME & STREET Address -UPS WILL NOT ship to PO Boxes! Name_______________________________________________________________ Company Name_______________________________________________________ Address_____________________________________________________________ City ________________________________________________________________ State / Zip ___________________________________________________________ Phone (very important) __________________________________ Fax _______________________________ Email _______________________________________________

B. Method of Payment visa Mastercard  or American Express

CHECK Enclosed . COD USA ONLY. Company Check / Cashier's Check.
Please make checks payable to Palisades Research.
VISA/MC#____________________________________ exp. ________Name on Card _______________________________________________ Signature ____________________________________________________VISA/MC/AMEX

C. Choose Items

Please refer to Item pages to check your compatibility before placing an order! Also, please read the Palisades Research Guarantee and Return Policy.

 Print this form and FAX or MAIL to us. Or, give us a call.

 

email info@aay.com