Items Quantity Item ID Description (optional) Price(each) ________ ______________ ____________________________________________ $____.____ ________ ______________ ____________________________________________ $____.____ ________ ______________ ____________________________________________ $____.____ ________ ______________ ____________________________________________ $____.____ ________ ______________ ____________________________________________ $____.____ ________ ______________ ____________________________________________ $____.____ ________ ______________ ____________________________________________ $____.____ ________ ______________ ____________________________________________ $____.____ ________ ______________ ____________________________________________ $____.____ ________ ______________ ____________________________________________ $____.____

Shipping Shipping Method: UPS GROUND ($6.50)

Order Total Item Total: $______________ IN Residents add 5% Sales Tax: $______________ Shipping Total: $6.50 *Total: $______________

Contact Information Phone # ________-________-______________ (ext. ________) Fax # ________-________-______________ Email _____________________________________________________

Shipping Address Shipping Address is a military APO Shipping Address is a business First Name: ______________________________________________________ Last Name: ______________________________________________________ Care Of/Company Name: ______________________________________________________ Street Address: ______________________________________________________ Street Address: ______________________________________________________ City: ______________________________________________________ State: ______________________________________________________ Zip: ______________________________________________________ Country (USA or Canada): ______________________________________________________

Billing Address Shipping and Billing are the same Address First Name: ______________________________________________________ Last Name: ______________________________________________________ Care Of/Company Name: ______________________________________________________ Street Address: ______________________________________________________ Street Address: ______________________________________________________ City: ______________________________________________________ State: ______________________________________________________ Zip: ______________________________________________________ Country (USA or Canada): ______________________________________________________

Purchase Order Purchase Order Name: _______________________________________________________ Purchase Order Number: _______________________________________________________ Purchase Order Date: ________/________/________

Credit Card Name as it appears on Credit Card _______________________________________________ Credit Card Type (check one) MasterCard Visa Discover American Express Credit Card Number _______________________________________________ Credit Card Expiration Date ________/________/________   You may mail or fax this form to IndyPC.com (an EarthWing, Inc. Company) at: IndyPc 1135 N. Exeter Ave. Indianapolis, IN 46222 Fax: 800-670-3848

Check/Money Order If paying by check or money order, please ensure that it is made out to "IndyPC.com" or "EarthWing, Inc." and that the amount matches that on the total line (in the "order totals" section) above. Please mail this form and payment to: IndyPc 1135 N. Exeter Ave. Indianapolis, IN 46222