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To place an order, please fill out the order form below. Be sure to include your shipping address, model number(s), quantity, and product description. For your convenience, you may place your order electronically by clicking on the "Submit" button. If you prefer, you can also print out this form by clicking on the "Print" button and fax your order to us at 574-267-6527. We accept Visa® and MasterCard®.

Order Form

Billing/Shipping Information

Name:
Company Name:
Address:

City:	State:	Zip:
Phone:	Fax:
e-mail:
e-mail confirm:

Order Information

Item(s):
Model #:	Qty:	Description:
Model #:	Qty:	Description:
Model #:	Qty:	Description:
Model #:	Qty:	Description:
Model #:	Qty:	Description:
Model #:	Qty:	Description:
Purchase Order Number:
Questions or Comments:

Credit Card Info

Credit Card Type:
Cardholder Name: (as it appears on the card)
Credit Card Number:
Expiration Date:
CVC/CVV: