FAX IN - OrderForm,
Appliance, A/C and Heating Parts
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OURAVERAGEDELIVERYTIMEIS2DAYS.
Please print this form and
attach additional sheets if needed.
You may fax this completed page 24/7 to: 1-386-490-4033.
Orders are processed 24 hours a day for fast delivery, you will 
receive an email order confirmation within 24 hours. Usually the 
part has already been shipped by the time you receive this.
 
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ORDER FORM
Attheendofthissecureformyouwillhavetheoptionforusto
doublecheckyourorderbymodelnumbertomakesureyoureceive
thecorrectpartbeforeweship.

 

  Please Print.
 If your ready to order, and know the part numbers, write them below.

 (1). Part Numbers:____________________________________________

 Item Quantity:__

 Item Description:___________________________________________

 Price Each or by the set:$______________

 Total Price:___________
 
 (2). Part Numbers:$___________________________________________

 Item Quantity:__

 Item Description:___________________________________________

 Price Each or by the set:$______________

 (3). Part Numbers:___________________________________________

 Item Quantity:__

 Item Description:__________________________________________

 Price Each or by the set:$______________


 
 Merchandise Price:$___________
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  SHIPPING:
 How would you like your part/s shipped? Circle or underline your shipping option.

Free UPS Ground Shipping, 48 States - My Order Is Over $150 for normal small items under 10lbs
$13 - UPS Ground 48 States
$35 - UPS 3 Day Select, 48 States
$45 - UPS 3 Day Select (A/C & Heat Motors,Compressors,Evap Coils 48 States
$55 - UPS 2nd Day Air Saver, 48 States
$80 - UPS 2nd Day (A/C & Heat Motors,Compressors,Evap Coils), 48 States
$81 - UPS Next Day Air Saver, 48 States
$120 - UPS Next Day (A/C & Heat Motors,Compressors,Evap Coils), 48 States
$122 - UPS Next Day Saturday Delivery
$145 - UPS Next Day Saturday Delivery - (A/C & Heat Motors,Compressors,Evap Coils
$60 - Hawaii-Alaska (Air)...2-7 Days
$95 - Hawaii-Alaska Next Day (Air)
$155 - Hawaii-Alaska Next Day (Air) -(A/C & Heat Motors,Compressors,Evap Coils)
$44 - Canada Delivery UPS, 1-7 Days
$41 - US Military Bases Outside The 50 States, Guam Etc
$65.00 - Overseas Delivery Postal, 3 - 10 Days

 Total Order After Shipping Charge $_______________________

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  BILLING INFORMATION:
 

  Your email address for an invoice we will send to you by email.

 ______________________________@___________________________

 Name. ______________________________

 Street Address.______________________________________________


 City._______________________   State.___________________

 Info for non USA or APO. __________________________________________ 

 Zip______________________     
 

  Home Phone______ ______ _______ Work Phone______ ______ _______


  SPECIAL INSTRUCTIONS OR DIFFERENT SHIPPING ADDRESS.

  ________________________________________________________


 ________________________________________________________

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  PAYMENT: CREDIT CARD OR CHECK (CHECK RECEIVES A 10% DISCOUNT).

 Card Type. Card Number.
 ________________ ____________________________

 Expiration Date.            Name (as it appears on card).
 _______ / ________      ___________________________________

  Card Holders Signature X_____________________________________

 PAY BY CHECK AND RECEIVE A 10% DISCOUNT
10% will be deducted when we receive your order. (USA BANKS ONLY FOR CHECKS)
Returned checks are subject to a $29 fee.

Customer information as it appears on your check:

Payer: __________________________________
Address: __________________________________
City, State & Zip: __________________________________
Phone: __________________________________

Customer Bank Information:

Bank Name: ___________________________________
State The Bank Is Located In: ___________________________________

Bank routing & account information - the line at the bottom of the check

EXAMPLE:

Routing Number:

___________________________

Checking Account Number:

  _____________________________

Check Number:

  ________________________

For your records take a check from your checkbook and fill it out just as you normally would.


  By ordering and filling out this form you agree to all terms and conditions.
 For questions call : 1-702-990-0683.
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   SIGNATURE   X______________________________________

 

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  Part Order Accuracy:
 If you are unsure this is the correct part for your appliance and would like us to recheck
  your part order for    accuracy before we ship, please enter your model # and serial # off the appliance,
  (not the manual). For   Amana and Speed Queen, also enter the MFR # starting with the letter P.
  (This  information is not required but   recommended so you get the right part the first time).
   If you need help finding this info call us. If there is any major change on your order you will
   be notified promptly by phone.
 

  BRAND___________________MODEL #____________________________

 SERIAL#_____________________________

  MFR# SOME AMANA'S__P___________________________________

 

  FOR OUR RECORDS. Please let us know why you have chosen to use our fax in form
  instead of ordering on our secure online order form.
  Have you had any problems with our online order form?

 _________________________________________________________________________________

 

 FAX 24/7 to: 1-386-490-4033.