Brenda (760) 217-0741 - Sales
Brenda@machinest.com
Fax (760) 246-5490

 

                                                         

Order by FAX

AluminumSpacers.com FAX Order Form - Fax to 760-247-9118

Order #___________(if applicable) UPS/FedEx Shipper #__________(if applicable)

Quantity Spacer Number Description Price Each Total Price
   

_____OD x _____ID x _____Long

   
   

_____OD x _____ID x _____Long

   
   

_____OD x _____ID x _____Long

   
   

_____OD x _____ID x _____Long

   
Shipping --Add $8.00 to regular shipping cost if shipped COD  
Total --  

Ship to:                  Print this form, complete it and Fax it to 760-247-9118

Name/Attn:____________________________________________

Company Name________________________________________

Address______________________________________________

Address______________________________________________

City_____________________State_______Postal Code________

Country_________________________

Phone #________________________ (Required outside of USA)

Email_______________________(This is so we can email confirmation and tracking numbers)

Circle Credit Card Type:     American Express    M/C    VISA    Discover

Credit Card #__________________________________

Expiration (Month/Yr)_______/________

Verification Number_______(Last 3 digits on the reverse side of card/4 digits on the face of AMEX)

Credit Card Billing Address: (If different from Shippng address)

Name___________________________________(Write 'Same' if same as above)

Company Name_________________________________________

Address_______________________________________________

Address_______________________________________________

City_____________________State_______Postal Code_________