Anderson Detector Shafts Printable Order Form

Anderson Detector Shafts Printable Order Form

Use your web browser's PRINT command to print out this order form. Fill it out by hand and send it to us by mail or fax.

Sold to: (Street address, not P.O. Box,
required for UPS delivery only)

Name:

Address:

City/State/Zip: _______________________

_______________________

_______________________

_______________________

Ship to: (if different from Sold To address)

Name:

Address:

City/State/Zip: _______________________

_______________________

_______________________

_______________________

Is delivery address a business or a residence?

Date: __________________________

If we need to call you about your order:
Day Phone No. ( ) ___________________ Evening Phone No. ( ) ____________________

	Quantity	Product#	Name of Item	Price Each	Total (Price x Quantity)	Shipping & Handling
1
2
3
4
5
6
7

Payment: We accept VISA and MasterCharge.Please make checks or money orders payable to : Anderson Detector Shafts. Call, fax or email for shipping charges. Please indicate location.

Payment Enclosed Credit Card

Card# Exp. Date

Signature

Product Total

Total Shipping & Handling

Subtotal

ON. GST 5% /PST 8% (Ontario delivery
addresses only) 13%

Total Order

Mail:
Anderson Detector Shafts
PO BOX 727, Ridgeway, ON L0S 1N0 Canada Phone:
(905) 346-2688