ZumbaTM ORDER FORM
EMAIL / FAX / MAIL completed form to:
2060 Chicago Avenue #C2
Riverside, California   92507
USA		   tel: (951) 686-5008
fax: (815) 346-1722
email: info@iscatech.com

 Customer Information
    Ship To:   Bill To  [If Different]:
 First Name:    
 Last Name:    
 Email Address:    
  Phone Number:    
  Fax Number: *    
  Company Name: *    
  Address:    
  City:    
  State/Province:    
  Zip/Postal Code:    
  Country:    
  Comments/
  Special Requests: *		  
 Fields marked with an * are optional.    All others are required.

 Payment Information
 Purchase Order Number: *  
 Payment method: [select one]     Credit Card [   ]       Check [   ]       Wire Transfer [   ]
 Credit Card Number:  
 Credit Card Type :    [circle one]     Mastercard    /    VISA    /     AMEX    /    Discover
 Expiration Date:    [mm/yy]  
 Name:  [as shown on credit card]  
 Signature:  

  Order Information
 Item Code  Product Description  Quantity  Unit Price  Total Price
         
         
         
         
         
         
         
         
         
         
         
.:  Subtotal 1:   
.:   Handling: 
For (Subtotal 1) amounts that are below $1000, add $8.95 per order: 		  
.:  Subtotal 2:   
.:  Sales Tax (7.75% for California resident):   
.:  Shipping: ** 
Contact Us if you have special shipping needs or if you need assistance.  		  
.:  Total:     


 ZumbaTM is a subsidiary of Isca Technologies.   By submitting this order form to ISCA, you have read and agree to ISCA’s  Standard Terms and Conditions of Sale.   Click here to review these terms and conditions.
 ** SHIPPING CHARGES: FOB Riverside, CA, USA., will be shown on invoice. You may leave this field blank or contact us for  estimate.
credit cards  ISCA Technologies, Inc. offers the following credit card processing.