Order Form

School Name: ________________________________________________(optional)

Name: ______________________________________________________

Address: _____________________________________________________

City: _______________________ State: ______  Postal Code: __________

Country: ___________________ Phone: _______________  Fax:__________________

Email Address: _________________________________________________________

Do you plan on adding Student Records to the Rocket Rally database?_______

(if so, you will be provided with a password to update information)

Product	price/unit	Qty	Total Price
Fully Assembled Rocket Launcher	$95.00
Unassembled Rocket Launcher kit	$70.00
Hand Air Pump w/gauge	$25.00
Clinometer	$25.00
100m measuring tape	$50.00
5x 1/2” Rocket Building tubes (reusable)	$5.00
Parts--
Sub Total -
Shipping (see chart below)
Total -

Please mail order form to:

Amok Science 161 East Netherwood Street Oregon, WI 53575

For other billing arrangements, contact Scott Mikkelson at sdmikkel@charter.net or call 608-443-8773