COMPUMATIC TIME RECORDERS, INC.			800-925-4506
828 BRUCE DRIVE					516-486-3538
EAST MEADOW, NY 11554			   FAX: 516-781-0990

Order form, please print and submit with payment       Date ____________

Last Name: ____________________ 	First Name: ____________________

Phone Number: (______) -______-________ ext (______)

Fax Number:   (______) -______-________

E-Mail: ________________________________________________________________

Shipping Address: (use company name if applicable)

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Item Name: ________________________________________________________

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Item Description (if applicable): _______________________________________________

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Quantity:  _______

Price (sub-total): $________.____

Shipping:          $________.____

Total:             $________.____

SIGNATURE _______________________________________________________________________


CHECK OR MONEY ORDER ACCEPTED
PLEASE MAKE FUNDS PAYABLE TO COMPUMATIC TIME RECORDERS, INC.

COMMENTS, SPECIAL INSTRUCTIONS, or PRINT PREFERENCE (if applicable):

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