KYE ORDER FORM

BED CONTROLLER ORDER FORM

Please print and mail this form with your check or money order to:

KYE
12 Mathew Bird Circle
Bozeman, MT 59715

(406) 586-2376

Please email us when you send your check and we will notify you when we will ship your order.

Ship to:

(name)_______________________________________________________

(address) _____________________________________________________

(city/state/zip)_________________________________________________

(phone)_______________________________________________________

(e-mail) _______________________________________________________

Bed Mfgr: _____________________

Bed Model:_____________________

11 December, 2007