Pinhole Glasses Order Form

PINHOLE GLASSES ORDER FORM

To order online, use the Shopping Cart.
To order by mail, print this form and send with your check to IMPA, 1054 Gravel Hill Road, Ligonier, PA 15658. Checks must be on a US bank in $US with machine-readable routing numbers at the bottom.

Note: Please use correct prices, $29 for traditional, $49 for modern models.

Model Name	Unit Price	Quantity	Total
			$
			$
			$
			$

Total.	$
Postage to countries outside the US. Add $30 to cover the postal rates.	$
Net	$

Shipping Information.
Enter a telephone number and/or email address in case of a question about your order.

Name:

Address 1:

Address 2:

City:

State (if used):

Postal Code:

Country:

Email (will be kept private):

Telephone (will be kept private):

Date:

Home