NITRO COMPANY ORDER FORM

7560 Newkirk Road, Mountain Grove, MO  65711
Phone: (417) 746-4600     Email: nitroammo@aol.com     Website: www.nitrocompany.com

Date:__________________

Name:___________________________________________________________________________
Company Name (if applicable)________________________________________________________
Street Address:____________________________________________________________________
City:______________________     State:________________     Zip:__________________
Phone:___________________________________________________________________________

ANY RETURNED CHECKS WILL BE CHARGED A $25.00 HANDLING FEE.

QUANTITY                    ITEM # AND DESCRIPTION                                                 PRICE                                        TOTAL
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INSURANCE PRICES
Configure From Merchandise Total

$0.01 to $100.00 is Free
$100.01 to $300.00 is $1.80
$300.01 to $400.00 is $2.40
$400.01 to $500.00 is $3.00
Add $.60 for each additional $100.00

Merchandise Total_____________
Shipping_____________
Insurance (Required over $100.00)_____________
Subtotal (Required)_____________
Missouri Residents Add Sales Tax of 5.225%_____________
Final Subtotal_____________
Add 4% Non-Cash Fee If Paying By Credit Card_______________
TOTAL_______________