FAX IN - Order Form

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Please print this form and
attach additional sheets if needed.
You may fax this completed page 24/7 to: 1-386-490-4033.
Orders are processed 24 hours a day for fast delivery, you will 
receive an email order confirmation within 24 hours.

 

  PLEASE PRINT THIS PAGE AND FILL OUT:


   HIGHEST PRICE FILTER FIRST, ADDITIONAL FILTERS RECEIVE 20% OFF

   FIRST FILTER - ELECTROSTATIC

   LENGTH_________________  WIDTH___________________ Circle Thickness   1"      2"

   PRICE$_________

  ADDITIONAL FILTERS RECEIVE 20% OFF DISCOUNT

 

  2nd  FILTER - ELECTROSTATIC

   LENGTH_________________  WIDTH___________________ Circle Thickness   1"      2"

   PRICE$_________

  3rd  FILTER - ELECTROSTATIC

   LENGTH_________________  WIDTH___________________ Circle Thickness   1"      2"

   PRICE$_________

  4th FILTER - ELECTROSTATIC

   LENGTH_________________  WIDTH___________________ Circle Thickness   1"      2"

  PRICE$_________
 

 Merchandise TOTAL:$___________

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  SHIPPING:
  Free ground shipping for all filters over $150 to the 48 states.
  Shipping times are for after the filter is made. (USUALLY WITHIN 24 HRS).

Please underline or circle your shipping option.

Free UPS Ground Shipping, 48 States - My Order Is Over $150.
$13 - UPS Ground 48 States
$60 - Hawaii-Alaska (Air)...2-7 Days
$44 - Canada Delivery UPS, 1-7 Days
$41 - US Military Bases Outside The 50 States, Guam Etc
$65.00 - Overseas Delivery Postal, 3 - 10 Days

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  BILLING INFORMATION:
 

  Your email address for an invoice we will send to you by email.

 ______________________________@___________________________

 Name. ___________________________________________

 Street Address.______________________________________________


 City.____________________________   State.___________________

 Info for non USA or APO. __________________________________________ 

 Zip______________________     
 

  Home Phone______ ______ _______ Work Phone______ ______ _______


  SPECIAL INSTRUCTIONS OR DIFFERENT SHIPPING ADDRESS.

  ________________________________________________________


 ________________________________________________________

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  PAYMENT: CREDIT CARD OR CHECK (CHECK RECEIVES A 10% DISCOUNT).

 Card Type. Card Number.
 ________________ ____________________________

 Expiration Date.            Name (as it appears on card).
 _______ / ________      ___________________________________

  Card Holders Signature X_____________________________________

 PAY BY CHECK AND RECEIVE A 10% DISCOUNT
10% will be deducted when we receive your order. (USA BANKS ONLY FOR CHECKS)
Returned checks are subject to a $29 fee.

Customer information as it appears on your check:

Payer: __________________________________
Address: __________________________________
City, State & Zip: __________________________________
Phone: __________________________________

Customer Bank Information:

Bank Name: ___________________________________
State The Bank Is Located In: ___________________________________

Bank routing & account information - the line at the bottom of the check

EXAMPLE:

Routing Number:

___________________________

Checking Account Number:

  _____________________________

Check Number:

  ________________________

For your records take a check from your checkbook and fill it out just as you normally would.


  By ordering and filling out this form you agree to all terms and conditions.
 For questions call : 1-702-990-0683
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   SIGNATURE   X______________________________________

 

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 FOR OUR RECORDS. Please let us know why you have chosen to use our fax in form
 instead of ordering on   our secure online order form. Have you had any problems with
 our online order form?

 ______________________________________________________________________________

                PLEASE FAX 24/7 to 1-386-490-4033.