Asymmetric 6716 Candy Lane Vermilion, OH 44089-3402	[Home]
	Please make your check or money order (or international money order in U.S. funds for non U.S. orders) payable to "Asymmetric" and mail to the above address along with this order form. Please allow three weeks for delivery.
	(Optional) Name:________________________________________ Phone:________________________________________ Email:________________________________________ Address:______________________________________  _____________________________________________  _____________________________________________ City:_________________________________________ County (Ohio Residents Only):_______________________________________ State:_______________ Zip Code:________________ Country:______________________________________ Please choose your model and quantity: QUANTITY MODEL PRICE EACH TOTAL   _____ Lead 342M $73.00 ___________ _____ Lead 342 $73.00 ___________ _____ Opera 545 $73.00 ___________ _____ 3C+544 $73.00 ___________ _____ POET $73.00 ___________ _____ VIRTUOSO $73.00 ___________ Shipping to US Customers: Please add $6.50 for the first mouthpiece and $2.00 for each additional mouthpiece. SUBTOTAL ___________ US SHIPPING ___________ Shipping to Non US Customers: Please add $8.50 USD for the first mouthpiece plus $5.00 USD for each additional mouthpiece. NON US SHIPPING ___________ Sales Tax: Ohio residents please add 6.25% of the subtotal. SALES TAX ___________ TOTAL ___________
	RETURN POLICY Mouthpiece(s) may be returned in saleable condition, subject to authorization, within 2 weeks. There is a $5.00 restocking and sterilization fee on all returns. Please call (440) 967-1470 for authorization before returning.