Print this form and fax to: NewWay Display & Graphics    dba Ted's Signs, Inc. at (704) 397-8520

Product Name____________________________

Model___________________________________

Quantity_________________________________

Price Each__________  Price Total___________

Shipping_________________________________

Total____________________________________

Name_____________________________         Ship to____________________________

Company__________________________                   ____________________________

Address___________________________                   ____________________________

City____________________ State____________ Zip___________

Phone_____________________

Email______________________________

Fax_______________________

                      Method of payment:
______Visa _____MasterCard ____AMEX

Card #________________________________ Last 3 numbers on back of card_________

Expiration Date__________

Name on card _______________________  Address & Zip code of card holder_________

NewWay Display & Graphics dba Ted's Signs, Inc.
1417 Alexander Street
Statesville, NC 28677        1-800-560-5260 phone   704-397-8520 fax