Cross Drilled Connection: Printer-Friendly Order Form

Please print this form for your mail order! (Not for use on-line)
Cross Drilled Connection		ORDER FORM
Tech: 1-860-974-9193 Sales: 1-866-974-9193		121 Boston Pike Pomfret Center, CT 06259

TO ENSURE PROMPT DELIVERY, PLEASE TYPE OR PRINT CLEARLY

SHIP TO:	BILL TO:
CUSTOMER #:	CREDIT CARD ORDERS ONLY
NAME:	NAME ON CARD:
C/O:	ADDRESS:
ADDRESS:	CITY:
CITY:	STATE:ZIP:
STATE:ZIP:	CONTACT PHONE: ()
DAY PHONE: ()	EMAIL ADDRESS:
HOME PHONE: ()

QTY	PART #	DESCRIPTION	UNIT PRICE	PRICE
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$

CARD #:		Sub Total	$
Expiration Date:	//
Card Holder Signature:		(6% in CT) Tax	$
Foreign Orders Only
Bank Issuing Card:		Shipping	$
Issuing Bank Phone #:		Total Due	$

FOR YOUR PROTECTION, WE THOROUGHLY INVESTIGATE THE VALIDITY OF ALL CREDIT CARD ORDERS!
If paying by check please allow extra time for delivery!
Please view the "Terms and Conditions" on the Order Policy page of our Web Site.