To place an order, print this form and fax or mail it to us:

JMAC ELECTRONICS

4859 W Slauson Ave. #207  Los Angeles, California    90056

FAX: 1 323 293-4088

FIRST NAME:  _______________________   LAST NAME: _______________________

   COMPANY: _________________________  ACCOUNT NO.  _____________________

   P.O. NO.:  ____________________     TELEPHONE: ________________________ 

   ADDRESS: __________________________  CITY: ___________________________

     STATE:_________________________   ZIPCODE:__________________________

 COUNTRY:_________________________________________

    E-MAIL: __________________________________________

Pay  Method: ____VISA  ____MC  ____American Express  ____Discover  ____PayPal

   NUMBER: _________________________   EXPIRATION DATE: ____________________

Signature:_________________________________________________

PRODUCTS ORDERED: