Ergonomic Products Fax/Mail Order Form

The Starfield Group, Inc.
Fax/Mail Order Form

You can print out this form by clicking on file and then on print.

E-MAIL ORDERS: starfield@ergostar.com
FAX ORDERS: 816-792-5522

PHONE ORDERS:  800-987-9074


BY MAIL:       The Starfield Group, Inc.
               P.O. Box 1395
               Liberty, MO 64069

ORDERED BY: **SHIP TO: (IF DIFFERENT)**

NAME: ________________________________ NAME: ________________________________

TITLE: _________________________________ TITLE: _________________________________

COMPANY: ____________________________ COMPANY: ____________________________

ADDRESS: _____________________________ ADDRESS: _____________________________

CITY: _________________________________ CITY: _________________________________

STATE: _______ ZIP: _______________ STATE: _______ ZIP: _______________


PHONE:  (     )  ______ -- __________

E-mail address:  ________________________________________

May we send you information at this E-mail address? ( YES / No )

PAYMENT METHOD  (Circle)   (Visa, Mastercard, Check, Money Order)


 IMPAC Cards

Card Number:  _______________________     Expiration date:  _______/_______

Signature:  _________________________________________

DESCRIPTION	QTY	PRICE	TOTAL PRICE
ITEM
ITEM
ITEM
ITEM
SUBTOTAL
Missouri residents add 6.725% tax
See chart below Shipping & Handling
Large Item surcharge if applicable
Total Amount

Thank You !

Shipping & Handling Chart
Back to order form
$ 0.00 - $20.00 = $ 6.95 $20.01 - $50.00 = $ 7.95 $50.01 - $75.00 = $ 8.95 $75.01 - $100.00 = $ 11.95 $100.01 - $150.00 = $ 14.95 $150.01 - $200.00 = $ 16.95 $200.01 - and over = $ 19.95
A $ 10.00 oversize surcharge applies for each workstation or AdjustaCart ordered.

Returns:  Before an item can be returned, you must call to get a return
merchandise authorization number.  Special order items may not be returned. 
Opened software may not be returned. All merchandise must be returned in its 
original packaging, complete with any instructions and other materials, in new condition, 
within 30 days.  A 25% restocking  fee will be charged.  Credit cannot be issued until 
The Starfield Group, Inc. has received and inspected the returned merchandise.  Opened 
packages of the ErgoStar® and software products may not be returned.  
All claims for damage/pilferage must be filed with the delivering carrier.  
Save all packing materials!  Prices are subject to change without notice.  
We reserve the right to substitute similar items of equal or greater value.  
Placing an order indicates acceptance of all the terms and policies stated herein.  
Details of warranties can be obtained free of charge by writing The Starfield 
Group, Inc.  Warranties and guarantees, if any, are offered by the manufacturer, 
not The Starfield Group, Inc.  After 30 days, please contact the manufacturer 
directly for any adjustments needed.

ORDERED BY:	**SHIP TO: (IF DIFFERENT)**
NAME: ________________________________	NAME: ________________________________
TITLE: _________________________________	TITLE: _________________________________
COMPANY: ____________________________	COMPANY: ____________________________
ADDRESS: _____________________________	ADDRESS: _____________________________
CITY: _________________________________	CITY: _________________________________
STATE: _______ ZIP: _______________	STATE: _______ ZIP: _______________

The Starfield Group, Inc.Fax/Mail Order Form

The Starfield Group, Inc.
Fax/Mail Order Form