SPOKIZ ORDER FORM

Name___________________________________________________________

Address__________________________________________________________

City_____________________________State___________Zip_____________

Phone__________________________________________________________

Number of Units__________________________________________________

Total $ Amount___________________________________________________

Note: One Unit is $80.00 plus $5.95 S/H

SEND your order form and payment to:

Spokiz
5018 S. 18th St
Omaha, NE 68107
USA
402.706-9909