Name: _________________________________________________________

Address To Which You Want Items Shipped:

CHECK HERE IF UPS IS OK  [  ] 

Street (Required For UPS): _______________________________________

Post Office Address: _____________________________________________

City: _____________________ State: _____________ ZIP: ______________

Phone Number If Not Using Email:__________________________________

Your Email Address_______________________________________________

• This is the problem I'm having with my telephone or dial:

• I would like an estimate of repair charges [  ]                                

• Other Comments:                                                                         

POST OFFICE:                VTS Industrial Company
                                              P. O. Box 429
                                               Salome, AZ 85348-0429

For UPS, FedEx, DHL:    VTS Industrial Company
                                              66776 E. Highway 60
                                       Salome, AZ 85348-0429