Parts Order Form

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Parts Order Form

Please fill out all fields for expedient delivery. All parts information is provided in manual.
NOTE:

"Unit Price" reflects the price of Quantity:1 of a part in your "Mechanical Parts List" and not a complete set of parts. Example: Ordering Quantity:1 of Part No: 63200P10 Spring (Smallest) will get you ONE spring and not five. If you would like a quantity of five please specify "5" in the "Quantity" space.
Name*

First NameLast Name

Parts Information

	Robot Model	Quantity	Part No.	Part Name	Unit Price	Dollar Amount (Unit Price x Quantity)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Parts Total (Add All Dollar Amounts) *
Shipping Options

Select one:
Standard Domestic Shipping USPS (5-7 business days)

$6.00
PRIORITY Shipping USPS (2-3 Business Days; Domestic Only)

$11.00
International USPS (Transit Time Varies)

$25.00
Sales Tax Calculation (CA ONLY)
Do you reside in the state of California? *

No (Skip Tax Calculation)Yes (proceed to sales tax calculation below)
CA SALES TAX: CA 10.75% ON PARTS (PARTS TOTAL AMOUNT x 0.1075)
Payment Method (select one)

VisaMastercard

Total Due*

USDTotal Due: (Parts Total + Shipping + tax (if applicable). Total amount subject to notice and cancellation if your calculation is incorrect.

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Use your mouse (if on a computer) or finger (touch screens only) to draw in the signature box below
Signature*
Email Address*
Phone Number*

Area CodePhone Number
Ship to (if different)

First NameLast Name
Shipping Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Should be Empty: