Starter-Pack Fax/Mail Order Form

KM Ant Pro LLC

P.O. Box 967 

Nokomis, FL 34275

Tel: (941)445-4252

Fax: (941)445-4253

Bill To Address:



Name: _____________________________________



Address1: _________________________________



Address2: _________________________________



City, State, Zip: _________________________



Day Phone: ________________________________



E-Mail address: ___________________________

Ship To Address: (If different)



Name: _____________________________________



Address1: _________________________________



Address2: _________________________________



City, State, Zip: _________________________



Day Phone: ________________________________



E-Mail address: ___________________________


Quantity	Description	Unit Price	Extended


__________	kmAntPro 4-Pack (without bait)	$83.00	__________

__________	kmAntPro 6-Pack (without bait)	$121.00	__________

__________	kmAntPro 8-Pack (without bait)	$154.00	__________

__________	Freight to Hawaii, Alaska and Puerto Rico	$8.00	__________

Visa ______ MasterCard ______ Check ______



Credit Card No. __________________________



Expiration _______________________________



Signature ________________________________

Subtotal _________________________________



Sales Tax 6.0% (Florida Only) ____________



Total ____________________________________

Instructions:

For mail or fax orders, please use the order form shown above.

The mailing address and fax number are shown above.

When paying by check, please allow 10 to 15 days for checks to clear.