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Send Orders To: Magnadyne Corporation
ATTN: Consumer Parts Sales
P.O. Box 5365
Carson, CA 90749-5365
SHIP TO: (No P.O. Boxes)
LAST NAME
STREET ADDRESS (IF PAYING WITH A CREDIT CARD, YOUR BILLING ADDRESS IS REQUIRED)
CITY
DAY TIME PHONE NUMBER
CREDIT CARD INFORMATION:
CARD TYPE:
VISA
CARD NUMBER
NAME AS IT APPEARS EXACTLY ON YOUR CREDIT CARD
Part #
Shipping and Handling
Subtotal + Tax
Add
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 A.M. and 5 P.M. weekdays. If UPS is unable to deliver, your order will be
© Copyright 2002
Magnadyne Corporation
Replacement Parts Order Form
STATE
MASTER CARD
Description
No C.O.D.'s
returned and additional shipping charges will be required.
We Accept Checks, Money Orders, Visa and Master Card
Make Checks Payable to: Magnadyne Corporation
FIRST NAME
ZIP CODE
EXPIRATION MONTH
Qty.
Sales Subtotal = ________ . ______
California Residents Add Sales Tax = ________ . ______
Shipping and Handling (See Chart) = ________ . ______
INITIAL
YEAR
Price Each
TOTAL
TOTAL = ________ . ______
MV-VCRUSER02
Rev. A 2-6-02
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