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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
E-MAIL ADDRESS
CITY STATE ZIP CODE
DAY TIME PHONE NUMBER
PAR
T # 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 $6.00
20.01 to 30.00 6.95
30.01 to 45.00 7.50
45.01 to 70.00 8.95
Over 70.01 9.95
VISA
MC
Call: (310) 884-7777 Fax: (310) 637-9542
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Replacement Parts Order Form
PLUS6900-UM.qxp 4/30/09 3:48 PM Page 19