PLEASE MAKE ALL CHECKS PAYABLE TO "Paleo Tools"
IF USING CREDIT CARD PLEASE ENTER #, EXP. DATE, SECURITY CODE (last 3 digit # on back of the card along the signature line) & SIGN

(CIRCLE ONE) VISA MASTERCARD AMERICAN EXPRESS NOVUS/DISCOVER

account number : __ __ __ __ - __ __ __ __ - __ __ __ __ -__ __ __ __

expiration date : Month/Year _____ / ____ security code: ______

Signature : ______________________________________________ Date:_______________

Bill To:	Ship To: .
Address: .	.
City: .	.
State and Zip: .	.
Country: .	.
Phone Number:	P.O. Number:


QUANTITY	DESCRIPTION	UNIT PRICE	AMOUNT
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.	..	S&H	.
For Utah Customers Please Write in Your Exemption Number.		TAX	.
.		TOTAL DUE