Instructions : Print this form and mail to address below or fax to
949-348-1915. Send questions to [email protected].
Newart
PO Box 2412
Mission Viejo, CA 92690-2412 PLEASE PRINT CLEARLY
Name _________________________________________
Address ______________________________________
City _________________________ State/Providence_____________ Postal Code ____________
Country ___________________ Email address : _________________________
Yes - please add me to your private mailing list : _____ NO! Do not add me:______
Please enclose check or money order payable to Newart. PLEASE PRINT CLEARLY.
My signature certifies that I am over 21 years of age and will not hold NewArt
liable for the use or misuse of any of the devices purchased. I understand no
guarantees have been made or implied and that purchases are not returnable.
Sign __________________________________________ Date : _____________________
Cylinders : Select this for more info on selecting the proper size cylinder.Lucite Expansion Cylinders,
standard sizes of 1 3/4" to 3" inside diameter and 9" to 12" length - $65.00 each. If you're
not sure what size to order send your dimensions, erect length along top & girth and we will send
the appropriate size Order sizes carefully as cylinders and pumps are not returnable for health reasons.
You need both a pump and a cylinder if you are beginning.
Cylinder Inside Diameter Length Quantity Price Total
#1 _____ (i.e, 2") ____ ______ X $65.00 $______
#2 _____ (i.e., 2") ____ ______ X $65.00 $______
Other Item ____________________________________________________________ $______
Brass Hand Pump : Quantity ______ X $35.00 $______
Nipple tubes in pairs :
Small - 1/ 2" ____ Quantity (# of pairs) X $55.00 $______
Medium 3 /4" ____ Quantity (# of pairs) X $55.00 $______
Scott Taylor instructional video - VHS Tape _____ Quantity X $15.00 $______
If ordering Package A (Cylinder, Pump, Video) enter $108.00 Subtotal $______
California residents add 7.75% tax CA Tax $______
Video alone add $4.00 for shipping.
Other orders up to $130.00 add $10.50 SHIPPING $______
Foreign countries add $15.00 for shipping.
Total $______
Credit Card Orders :
Credit CARD NUMBER:______________________________________ EXPIRES _______
NAME as it appears on Credit Card:___________________________________________
Visa ____ Mastercard ____ American Express:____ Discover:___