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WWW.STONEAGECONCRETETOOLS.COM
This is a primative printable fax form used to
place and order by mail with a check or credit card # and Fax in (631) 728-1719
PLEASE
TAKE CARE WHEN DIALING.
Bill to:________________________________
Name:__________________________________
Address:________________________________
City:___________________________________
Phone:__________________________________
Email:__________________________________
Ship
to:_______________________________
Name:________________________________
Address:_______________________________
City:__________________________________
Phone:________________________________
Email:________________________________
Is this a comercial address Yes_____ No______
E-Z Mesh TM must be shipped freight, call for
pricing. |
Quantity
Item #
Description
Weight
Item Total
(1.)_________________________________________________________________________________
(2.)_________________________________________________________________________________
(3.)_________________________________________________________________________________
(4.)_________________________________________________________________________________
(5.)_________________________________________________________________________________
Sub Total $
______.___
Add NY Tax $ _____.__
If sending a
check
shipping must be added
Shipping $________.____
Order total $ ______.___
If mailing your order: Checks or money order must be
enclosed (No starter checks)
NY residents must
add applicable sales tax.
Make checks payable to: Stoneage Concrete
Tools
Mail to: 23 Duvall
Drive Hampton Bays, NY 11946-3038
Credit /Debit Card:
Circle
one: Visa MasterCard
Card
#_________________________________
Exp.
Date_______________________________
Code 3 digit____________
Name as it
appears on card______________________________________________________
Is
this a points or rewards/ miles card? circle
one: YES
NO
Delivery method: Must have street
address for delivery. No P.O. Box #
See terms & conditions at
www.stoneageconcretetools.com.
THIS FAX IS INTENDED FOR
STONEAGE CONCRETE TOOLS ONLY! If you have received this message in error, please
immediately notify the sender. This faxed message contains confidential
information. If you are not the intended recipient (STONEAGE CONCRETE TOOLS),
you are hereby notified that any dissemination, distribution, or copying of this
FAX is strictly prohibited. PLEASE CONTACT THE SENDER AND DESTROY
THIS TRANMISSION. Other than use for intended purpose, no part
of this form may be used without written consent of Stoneage Concrete Tools.
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