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

JMAC ELECTRONICS

29820 Camino Cristal  Menifee, Ca 92584

FAX: 1 951.263.3772

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:
Part No.: Quantity: Decsription: Price: Shipping: Subtotal:
      $ $ $
           
           
           
           

Total

$

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