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Replacement Parts Order Form
Credit Card or Money Order Only
(Sorry No Cash, C.O.D. or personal checks accepted)
Call: (310) 884-7777 Fax: (310) 637-9542
SHIP TO: (No P.O. Boxes)
LAST NAME
STREET ADDRESS
ADDITIONAL ADDRESS
ADDITIONAL ADDRESS
CITY
DAY TIME PHONE NUMBER
CREDIT CARD INFORMATION
CREDIT CARD N0.
CARD HOLDER'S LAST NAME
STREET ADDRESS
CITY
PART #
DESCRIPTION
Shipping and Handling
Up to $20.00
$5.00
20.01 to 30.00
5.95
30.01 to 45.00
6.50
45.01 to 70.00
6.95
Over 70.01
7.95
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.
Mail to: Magnadyne Corporation
ATTN: Consumer Parts Sales
P.O. Box 5365
Carson, CA 90749-5365
FIRST NAME
STATE
ZIP CODE
EXPIRATION DATE
FIRST NAME
STATE
ZIP CODE
QTY.
PRICE EACH
Sales Subtotal = ________ . ______
California Residents Add Sales Tax = ________ . ______
Shipping and Handling (See Chart) = ________ . ______
TOTAL = ________ . ______
INITIAL
VISA
MC
INITIAL
TOTAL
19
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