Order Form

Product Description	Model or Item Code Number	Qty	Price

For BlowerWheels click & add this Form For Fan Blades click & add this Form

(Shipping Method) Shipping and Handling Charges will be Added.
Billing Information as it appears on your credit card.
Billing address must be entered exactly as it appears on your credit card statement. Check your statement for accuracy to avoid delays in your order.

Full Name:

Company Name if company card:

Address:

City:

ST:

Zip:

E-mail:

Shipping Information: Please indicate if the destination is a
Due to shipper restrictions we cannot deliver to P.O. Boxes, APOs or FPO

Full Name:

Company Name if company card:

Address:

City:

ST:

Zip:

E-mail:

(Payment Method) Electric Trading Company collects local sales tax (8.375%) on orders shipped to NY State.
Please note that paying by check or money order requires extra processing time. We are currently unable to process any credit cards that are issued
or billed outside of the United States. Payment in full must be received prior to shipment in US dollars. Make check and money order/cashiers check
payable to: Electric Trading Co. Mail check or money order/cashiers check to: Electric Trading Co., PO Box 692, New York, NY 10013

Card Number: - - -

Expiration Date: MM YYYY VIN: What is VIN ?

Signature:_____________________________________________Date:_________________

Order Form Type in the form - Print the form and fax to (212) 941-1796