Please fill out the following form
AND
|
Mail to:
Voltage Converter Transformers ILL.- 60172 |
OR |
Fax
To: Voltage Converter Transformers Fax
1(847)-595-9900 |
|
I
,
___________________, Authorize Voltage Converter Transformers to
charge my credit card for the purchase of the item(s) listed
below. |
|
Name on Credit
Card: |
|
LAST:_____________________FIRST:____________________MIDDLE:_______________ |
|
e-mail:___________________________________ |
|
TELEPHONE
NUMBER(S):
WORK (____)______________
Cell (____)______________
HOME
(____)______________ Fax
(____)______________ |
|
CARD TYPE: |
|
CARD#:______________________________________ EXP
DATE________________ |
|
BILLING
ADDRESS: |
|
__________________________________________________________________________________ |
|
SHIPPING
ADDRESS: |
|
__________________________________________________________________________________ |
|
Phone number for the card
issuing bank (Usually on back of card):
_____________________________ |
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PAGE 1 of
2 |
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Quantity
|
DESCRIPTION
|
UNIT PRICE
|
TOTAL
|
|
_____________
|
_____________________________
|
_________________
|
____________________
|
|
_____________
|
_____________________________
|
_________________
|
____________________
|
|
_____________ |
_____________________________ |
_________________ |
____________________ |
|
_____________
|
_____________________________
|
_________________
|
____________________
|
|
_____________
|
_____________________________
|
_________________
|
____________________
|
|
|
SHIPPING CHARGES |
____________________
| |
|
|
IL Residents add 7.75%
tax |
____________________ | |
|
|
|
GRAND
TOTAL FOR THIS
ORDER |
$______________
USD |
TERMS
AND CONDITIONS:
We
always carry top quality products which have been approved by our technical
staff. This lets us sell our products with total confidence. However, as with
all machine made products some repair work might become necessary and the
following terms apply:
Sign here to confirm order
____________________Date ________
PAGE 2 of
2