Order Form

 



Silver State Renewables, Inc.
2074 Sawyer Way
Elko, NV  89801

Phone: (775) 738-4812
Fax: (775) 738-4812
Email: mjkerna@silverstaterenewables.com
Website: http://www.silverataterenewables.com

 
Ordered by: (please print)
NAME____________________________
ADDRESS_________________________
CITY_________________ STATE______
ZIP CODE_________________________
DAYTIME PHONE # (___)___-_________
EMAIL____________________________
Ship to: (if different)
NAME____________________________
ADDRESS_________________________
CITY_________________ STATE______
ZIP CODE_________________________
DAYTIME PHONE # (___)___-_________
EMAIL____________________________

Product or Service Desired

QUANTITY

DESCRIPTION

PRICE EACH

TOTAL PRICE

       
       
       
       
       
       
Payment Method: (circle one)  
   Personal Check Note: Make checks and money orders payable to Silver State Renewables, Inc.
   Money Order

Total

 

Shipping/Handling

 $4.00

Add Sales Tax
(NV-6.5%)

 

Total Enclosed

 

Prices are subject to change without notice.

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This material may not be reproduced or redistributed without prior written permission. Thanks!