

2804 Waterford Circle
Nashville, TN 37221
615.673.9194 (ph/fax)
www.edugator.com
gator@edugator.com
BILLING INFORMATION:
(Please print, and fill out completely)
_____________________________________
Name
Shipping Information
_____________________________________
Address (Please print)
______________________________________
___________________________________________
City, State,
Zip Name
(______)_________________________________ ___________________________________________
Daytime phone number Address (P.O. Box, if applicable, & Street Address)
______________________________________
School Name ___________________________________________
(Date)_________________________ City, State, Zip
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IP# |
QUANTITY |
ITEM NAME |
PRICE EACH |
PRICE TOTAL |
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[If more room is needed, please use additional page(s) or the back of this form]

Shipping $ Handling $ ___________
Sales Tax*** $ ___________
TOTAL ENCLOSED $ _________
Payment:
___ A check payable to Makitso, Inc. ___ Official Purchase Order #_______________
Credit Card Payments
___ Visa ___ MasterCard
Credit Card #_________________________________ Expiration Date: __________
Address:_____________________________________________________________________
(if billing address is different than the address listed above)
Cardholder name: ________________________Signature:______________________________
(PRINT) (Required for processing)
Thank You for Your Order!