FAXABLE ORDER FORM (2/06)                                                               FAX to (714) 630-8025 Print and fax, or call in your order to (714) 630-8024, between 8:30am-5:00pm PST (California)

Part # Price Qty Subtotal Part #  Price Qty Subtotal Part # Price Qty Subtotal B500-3P  3 Bd Only $52.50  ___  _______   P500  Dev Bd  $39.95  ___  _______  P530  MLF .65 .8 E $59.95    ___  _______  C800  20 40p  $12.60  ___  _______  P501  DB Conn  $39.95  ___  _______  P531  MLF .65 .8 O $59.95    ___  _______  C801  20 40p RA $15.40  ___  _______  P501-SP  P501 Parts  $69.95  ___  _______   P532  MLF .4 .5 E $59.95    ___  _______  C802  10 80p  $11.55  ___  _______  P502  Small/Mod  $48.50  ___  _______  P533  MLF .4 .5 O $59.95    ___  _______  C803  10 80p RA  $18.60  ___  _______  P502-SP  P502 Parts  $44.95  ___  _______   P534  48pin .65 .5 $48.50    ___  _______  C804  10 36p Skt  $19.25  ___  _______  P503  Two Row  $48.50  ___  _______  P535  MLF 4-32p $59.95    ___  _______  C805  Multipack  $39.70  ___  _______  P504  Quad  $52.50  ___  _______  P536  TSSOP .5 $62.50    ___  _______  CC520  SO 16 pad $72.95  ___  _______    P505  SOIC  $49.95  ___  _______  P537  TSSOP .4 $62.50    ___  _______  CC521  SO 8 pad  $69.95  ___  _______    P506  USB RJ  $49.95  ___  _______  Q20-18  Quad 3-Pk  $14.50  ___  _______  CC522 SO 32 pad  $79.95  ___  _______    P507  TSSOP  $49.95  ___  _______  Q20x2  Quad 3-Pk  $14.50  ___  _______  CC523  SO 28 pad $79.95  ___  _______    P508  Metric+  $48.50  ___  _______  Q22-20  Quad 3-Pk  $14.50  ___  _______  CC524  SO 24 pad  $79.95  ___  _______    P509  50/25 mil  $48.50  ___  _______  Q28-32  Quad 3-Pk  $28.50  ___  _______  CC525  SO 48 pad $72.95  ___  _______    P510  SO8  $62.50  ___  _______  Q28x1  Quad 3-Pk  $14.50  ___  _______  CC526  SO 40 pad $72.95  ___  _______    P511  SOIC DIP  $55.50  ___  _______  Q32-28  Quad 3-Pk  $32.50  ___  _______  CC527  SO 14 pad $72.95  ___  _______  P512  PLCC  $59.95  ___  _______  Q48-44  Quad 3-Pk  $49.50  ___  _______  K900  P500-504  $169.95  ___  _______  P513  Small  $59.95  ___  _______  Q52-48  Quad 3-Pk  $49.50  ___  _______  K901  Case Kit  $98.50   ___  _______  P514  SOIC N DIP  $59.95  ___  _______  Q54-44  Quad 3-Pk  $49.50  ___  _______  K904  Quad $289.20  ___  _______  P515  SOIC DIP.6  $59.95  ___  _______  Q64-52  Quad 3-Pk  $49.50  ___  _______  K905  Project $201.84  ___  _______  P516  TSSOP .65  $62.50  ___  _______  Q64-64  Quad 3-Pk  $49.50  ___  _______  K910  Lab 10  $377.50  ___  _______  P517  TSSOP 48  $62.50  ___  _______  Q70-80  Quad 3-Pk  $49.50  ___  _______  K912  Lab 12  $480.86  ___  _______  P518  QFP .65/,8 $59.95  ___  _______   Q80-80  Quad 3-Pk  $49.50  ___  _______  K915  Lab 15  $599.24  ___  _______  P519  QFP .4/.5 $59.95  ___  _______   Q100-80  Quad 3-Pk  $49.50  ___  _______                          Q100-100  Quad 3-Pk  $49.50  ___  _______

Name*                                                              Company* Email (for order confirmation):                                                           Resale?*  (   ) No, or resale #: Phone #:*                                                         Fax #:   USA only*,                (   ) UPS Ground      (   ) UPS 3 Day      (   ) UPS 2 Day      (   ) UPS Next Day International only*:  (   ) UPS Express             All USA and Int'l shipping: we add exact UPS charge to bill. Ship To: Name* Ship To: Street Address* Ship To: City/State/Zip/Country*   Bill To: Street Address* Bill To: City/State/Zip* County: (California only, for sales tax) Purchase Information:*     Company Purchase Order # ____________________ OR: [ (   ) Visa     (   ) MC     (   ) AMEX ]    Card #:                                                  Expiration: Name on Card: Card: Street/City/State/Zip Note: Company P.O.'s Net 30, US currency only.  Individuals: Visa/MC/AMEX only.      International: Advance payment may be required. Where did you hear about us? * = required for placing order.  Please print clearly so we can serve you effectively.

Need more information?  Call (714) 630-8024 8:30am - 5:00pm Pacific time, or sales@beldynsys.com.