CLIPLOADER ORDER FORM
DATE: ____________________
NAME: _____________________________________________________________________
ADDRESS: ______________________________________________________________________
CITY: ____________________________________ STATE: __________ ZIP: ______
PHONE: __________________________ FAX: _____________ EMAIL: __________
QTY. COLOR TOTAL
_____ INDIVIDUALS @ $22.50 each _____________ ___________
_____ MULTIPLES OF 6 @ $15.50 each _____________ ___________
_____ MULTIPLES OF 50 @ $14.00 each _____________ ___________
_____ MULTIPLES OF 100 @ $11.00 each _____________ ___________
_____ MULTIPLES OF 500 @ $10.75 each _____________ ___________
(PA RESIDENTS ONLY) PA SALES TAX ____________
SHIPPING & HANDLING ____________
(In the Continental United States)
Shipping is usually ($3.00 for 1, $6.00 for 2, and $8.00 for 6)
Orders of 50 or more we pay the shipping on. (In the Continental United States)
TAX EXEMPT#____________________ TOTAL: _____________
Cliploader Colors: Amber, Blue, Clear, or Green
NOTE: Amber is the default color. If no color is marked, we will send Amber.
PAYMENT METHOD:
¨ CHECK or MONEY ORDER - #___________ D.L.(State,#) _____________
¨ CREDIT CARD - VISA MASTERCARD, Only
Acct No. _______________________________________Exp.Date ___________
3 digit V-code ______________
Signature____________________________________________________________
ORDER INFORMATION:
Phone 724-459-9278
Fax 724-459-0735
E-Mail Debbie at djamison@mcfaden.com
Address McFadden Machine Co., Inc.
160 Hill Road
Blairsville PA 15717