Name____________________________________ mail orders to: Address_________________________________ SANDBOX AUTOMATIC 245 West 29th Street 9FL ________________________________________ New York, NY 10001 24-hour fax line: ________________________________________ (212) 631-0339 e-mail address__________________________ checks are payable to: SANDBOX AUTOMATIC, INC. day phone w/area code___________________ Item Name Price Qty Total ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ (for additional items, attach another sheet to this one) Sub-Total: ________ shipping rates listed at: http://sandbox.pair.com/help.html N.Y. add 8.625% sales tax: + ________ Total shipping units: __________ Shipping/Handling: + ________ Pay this amount: ________ Pay using: ____Check/MO ____ VISA ____ M/C ____ AMEX ____ Discover ___________________________________ ________ card number exp.date ___________________________________ _____________________________ name on card authorized signature Please provide credit card billing address and phone if not listed above::