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FAX ORDER FORM |
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Fax or Check Orders |
The following form can be used to order any part or accessory. When you are done filling in the form, please print this page and fax it to us. Fax to: 1-219-395-9398. This will ensure that your credit card information is secure.
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Shipping Address |
Credit Card Holder's Address |
| Name: | Name | ||
| Address | Address | ||
| City | City | ||
| State | State | ||
| Zip | Zip | ||
| Phone | Phone | ||
Method of payment (please check one) Visa MasterCard American Express
Discover Check or Money Order
Make check payable to: 1st Garage Door Openers Inc., 1107 N 100 E, Chesterton, IN 46304
| Card Number | Exp. Date | ||
| Print Name | Today's Date |
| SIGNATURE Please be sure to sign this form before faxing or mailing. |
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QTY |
PART # |
DESCRIPTION |
PRICE EACH |
TOTAL |
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| SHIPPING CHOICES (choose one) |
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$ 7.95 | |||||
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$ 35.00 | |||||
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$22.00 | |||||
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SUB TOTAL |
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| TAX MUST BE ADDED TO SUB TOTAL | ||||||
| Florida Residents Add | Sales Tax (7%) | |||||
| Indiana Residents Add | Sales Tax (7%) | |||||
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TOTAL ORDER |
