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Print this form and phone, fax or mail your order today.
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Order Code
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Qty.
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Product Description
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Price/Ea.
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Total
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Subtotal
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Sales Tax (NY only) 7%
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Shipping*
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Total
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Name:
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Phone No.: (for order verification)
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Organization:
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Address 1:
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Address 2:
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City:
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State:
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Zip:
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Country:
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Billing address (Complete if different from shipping address above:)
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Name:
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Address:
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City:
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State:
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Zip:
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Country:
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Method of Payment
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Check Enclosed (payable to Tec-Ease, Inc.)
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Purchase Order Number:
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Credit Card Type:
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Visa, Master Card, American Express, Discover & Diners Club accepted.
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Number:
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Expiration:
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Name on card:
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Please allow 2 weeks for delivery. Occasionally, we may be
temporarily out of stock on an item, in which case we will notify you that there will be a delay.
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Mail order to:
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Tec-Ease, Inc.,
59 Greco Lane, Dunkirk, NY 14048
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Fax order to: (716) 785-6126
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Phone: (888)832-3273, outside the USA (716) 785-6015
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Return to on-line store
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