CPS - Order Form

BILL TO:                                    SHIP TO: (If Different)

Name______________________________________  Name______________________________________

Company Name                                Company Name
(If Applicable)___________________________  (If Applicable)___________________________

Address___________________________________  Address___________________________________

City,State,Zip____________________________  City,State,Zip____________________________

Tel_________________ Fax__________________  Tel_________________ Fax__________________

E-Mail (For Confirmation)_____________________________________________________________

 Item #            Description            Quantity  Ship Wt  Cost Each  Total Amount

_________  _____________________________  ________  _______  _________  ____________

_________  _____________________________  ________  _______  _________  ____________

_________  _____________________________  ________  _______  _________  ____________

_________  _____________________________  ________  _______  _________  ____________

_________  _____________________________  ________  _______  _________  ____________


                                                   Sub Total            ____________

                                                   Add US$3.00 Handling
                                                   for US shipments and
                                                   US$15.00 for shipments
                                                   outside of the US.   ____________

                                                   Add Applicable 
                                                   Sales Tax (GA Only)  ____________

                                                   Shipping Charges
                                                   If using C.O.D, Wire
                                                   Transfer, or 
                                                   Cashier/Company Check,
                                                   call for amount.
                                                   Amount will be added
                                                   by CPS for Credit
                                                   Card orders          ____________

                                                   COD - Add US$7.50    ____________


                                                  Total                ____________

                       METHOD OF SHIPMENT:

__ UPS Ground

__ 3 Day Service

__ 2 Day Air Service

__ Next Day Air Service (PM Delivery)

__ Next Day Air Service (AM Delivery)

__ International Shipments (Please call for freight quote)

                       METHOD OF PAYMENT:

__ Visa  __ MasterCard  __ American Express

Account Number________________________________ Exp. Date__________________

Security Code _________  (For American Express - 4 digits on the front
                          For Visa/MasterCard - 3 digits on the back)

Cardholder Printed Name___________________________________________________


__ C.O.D. (Money Order/Cashiers Check Only, Call for Transaction Total)

__ Wire Transfer (Call for account information)

__ Check - Prepay (Please make Money Order/Cashiers Checks payable to: Computer 
          Peripheral Solutions, LLC, Call for Transaction Total)

Note: Prepayment and C.O.D. not available for export shipment.

__ Net 30 Days (Account must be previously established. Authorized P.O. # required)

      Purchase Order Number: _____________________________________________

                       30 Day Guarantee:
If you are not completely satisfied, we will gladly replace the merchandise
or, if you prefer, refund your purchase price of the unit within 30 days.

                       Exchange Returns:
If you need to exchange or return products within 30 days, please include
all original packaging and paperwork you received with your order and contact us at
770-638-7640 to receive a Return Authorization number (RMA).

NOTE: Software, Custom products and Special orders are not exchangable, returnable 
or refundable.