BassRx The Right Prescription for Bass Tournaments

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Printable Order Form Use your web browser's print command to print out this order form. Fill it out by hand and send it to us by mail.

Sold To:

Name:

Address:

City/State/Zip:

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Ship To: (if different from sold to)

Name:

Address:

City/State/Zip:

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Please send check or money order payable to:

KGS Technologies

749 Kingston Drive

McBee, SC 29101

Product#	Item	Quantity	Unit Price	Unit Subtotal	Shipping & Handling	Total
BRX1	BassRx One Pound Bottle		$6.99		$5.50 For 1 Bottle, $1.25 For Each Additional Bottle
BRX1-12	BassRx One Pound Bottle, Case of 12		$79.99		$15.00 Each Case
BRX20	BassRx 20 Pound Bucket		$99.99		$20.00 Each Bucket

					Subtotal
					SC Residents Add 6% Sales Tax
					TOTAL DUE

Date: __________________________

If we need to call you about your order:

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