CLIPLOADER ORDER FORM
DATE: ____________________
NAME: _____________________________________________________________________
ADDRESS: ______________________________________________________________________
CITY: ____________________________________ STATE: __________ ZIP: ______
PHONE: __________________________ FAX: _____________ EMAIL: __________
Cliploader Colors: Amber, Blue, Clear, or Green
NOTE: Amber is the default color. If no color is marked, we will send Amber.
QTY. COLOR TOTAL
_____ INDIVIDUALS @ $21.95 each _____________ ___________
_____ MULTIPLES OF 6 @ $15.00 each _____________ ___________
_____ MULTIPLES OF 50 @ $13.50 each _____________ ___________
_____ MULTIPLES OF 100 @ $11.00 each _____________ ___________
_____ MULTIPLES OF 500 @ $10.75 each _____________ ___________
PA SALES TAX ____________
SHIPPING & HANDLING ____________
(In the Continental United States)
Shipping is usually ($3.00 for 1, and $7 - $8 for 6)
Orders of 50 or more we pay the shipping on. (In the Continental United States)
TAX EXEMPT#____________________ TOTAL: _____________
PAYMENT METHOD:
¨ CHECK or MONEY ORDER - #___________ D.L.(State,#) _____________
¨ CREDIT CARD - VISA MASTERCARD
Acct No. _______________________________________Exp.Date ___________
3 digit V-code ______________
Signature____________________________________________________________
ORDER INFORMATION:
Phone 724-459-9278 (Mon. - Fri. 7:30am - 4pm EST)
Fax 724-459-0735
E-Mail djamison@mcfaden.com (information only)
Address McFadden Machine Co., Inc.
160 Hill Road
Blairsville PA 15717