Parts and accessories order form, Credit card or money order only, Visa mc – Carbine PLUS 6850 User Manual

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Credit Card or Money Order Only

(Sorry No Cash, C.O.D. or personal checks accepted)

SHIP TO: (No P.O. Boxes)

LAST NAME

FIRST NAME

INITIAL

STREET ADDRESS

ADDITIONAL ADDRESS

ADDITIONAL ADDRESS

CITY

STATE

ZIP CODE

DAY TIME PHONE NUMBER

PART #

DESCRIPTION

QTY.

PRICE EACH

TOTAL

Sales Subtotal = ________ . ______

California Residents Add Sales Tax = ________ . ______

Shipping and Handling (See Chart) = ________ . ______

TOTAL = ________ . ______

On regular orders please allow 4-5 weeks for delivery.

Please give a shipping address where this order may be delivered between the hours of 9 am and 5 pm weekdays.

If UPS is unable to deliver, your order will be returned and additional shipping charges will be required.

CREDIT CARD INFORMATION

CREDIT CARD N0.

EXPIRATION DATE

CARD HOLDER’S LAST NAME

FIRST NAME

INITIAL

STREET ADDRESS

CITY

STATE

ZIP CODE

Mail to: Magnadyne Corporation

ATTN: Consumer Parts Sales

P.O. Box 5365

Carson, CA 90749-5365

Shipping and Handling

Up to $20.00

$5.00

20.01 to 30.00

5.95

30.01 to 45.00

6.50

45.01 to 70.00

6.95

Over 70.01

7.95

VISA

MC

Call: (310) 884-7777 Fax: (310) 637-9542

Parts and Accessories Order Form

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PLUS-6850-UM 12/27/06 9:07 Page 18

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