K1 Machine Order Form (ID)
	Date of Order:                                  Date Paid:
		Name	Distributor Number
	Distributor	Kay Ekwall
	Customer Name
	Customer Address
	Customer Phone
	Customer E-Mail
	Shipped                Delivered                Clinic Pickup             Airpark Pickup
	Machine Price		$
	Tax (7.95% in AZ, 0% in other states)		$
	AZ Delivery Charge		$
	Shipping Charge		$
	Total to Run		$
	Circle Method of Payment	Visa - M/C - AMEX - Discover  Care Credit - Money Orders -Cashiers Check - Cash or Wire Transfer (esp out of states)
	Write card number below if paying by credit card
	Card Number
	Expiration and CVV2 Code
	Billing Address (if different than above)
	Fax to Aesthetic MD immediately (480)991-0471                                                          Or Mail to 7601 E Gray Rd STE A Scottsdale, AZ 85260
	Updated 06/07