Order Form for Kits and Replacement Parts.
Print off a copy on the printer and fill out.
NAME: __________________________________
ADDRESS: _______________________________
CITY, __________________, STATE: _________ ZIP: _________________
PHONE: ( _____ ) ______ - ____________
| | PART NUMBER | DESCRIPTION | QUANITY | | COST EACH | TOTAL |
| 1 | | | | X | | |
| 2 | | | | X | | |
| 3 | | | | X | | |
| 4 | | | | X | | |
| 5 | | | | X | | |
| 6 | | | | X | | |
| 7 | | | | X | | |
| 8 | | | | X | | |
| 9 | | | | X | | |
| 10 | | | | X | | |
| | | | | | SUB TOTAL |
|
| | | SHIPPING CHARGES ARE ACCORDING TO CHART BELOW: | | | SHIPPING COST |
|
| | | | | | TOTAL COST |
|
| | MERCHANDISE TOTAL | 48 CONTIGUOUS STATES |
| 1 | $ 0.00 - $ 40.00 | $ 6.99 |
| 2 | $ 40.01 - $ 60.00 | $ 8.99 |
| 3 | $ 60.01 - $ 80.00 | $ 10.99 |
| 4 | $ 80.01 - $ 100.00 | $ 12.99 |
| 5 | $ 100.01 - $ 150.00 | $ 14.99 |
| 6 | $ 150.01 - $ 200.00 | $ 16.99 |
| 7 | $ 200.01 - $ 300.00 | $ 17.99 |
| 8 | $ 300.01 - $ 500.00 | $ 19.99 |
Print off a copy on the printer and fill out and mail to: Ray Longbrake 16740 Indian Hollow Rd.
Grafton, OH 44044
CHECKS AND MONEY ORDERS ARE TO BE MADE OUT TO:
"Ray Longbrake."
Orders will be shipped out two to four weeks after receipt of payment.