Sandown Wireless Order Form

                                                     Mail To: 19 Phillipswood Road

                                                             Sandown, NH 03873

             Office: 603-425-9876   Cell: 603-548-0125  Fax: 603-887-2117  E-mail: wa1hzk@usa.net

                                   Print Page & Please Print Clearly, All Required Information

                                           Microsoft Word Version     Adobe .pdf Version    

           Sold To: (credit Card Billing Address)                                       Ship To: (Final Destination)

Name: __________________________________________  Name: ________________________________________

Address: _______________________________________  Address: _______________________________________

City: __________________State: ____ Zip:___________  City: ___________________State: ____Zip:__________

Telephone: __________________________ Fax: _______________________ e-mail: _________________________

                         Check Enclosed  ____    Money Order Enclosed ____     Credit Card Order ____

Purchase Order Number: (______________)  Master Card: ___  Visa: ___  Discover: ___

Card Number: _______________________________________________________________

Sec. Code: ________Exp. Date: ___________Name On Card: _________________________

Signature (Required if using Credit Card) ________________________________________

Returns: Full Refund Offered for 30 days if not satisfied with Supplied Products. Items must be

returned as new unused parts. We will make every effort to supply the correct parts for your use.

Item Manufacturer, if known: ________________________________

*Please Supply Exact O.E.M Equipment Model and Item P/N if you have it.

*Model: ___________________________ *OEM P/N # ______________________________

Qty---------Part Number-----------------Description---------------------------Price Each----Item Total

_____  ______________  ___________________________________  _________  ___________

_____  ______________  ___________________________________  _________  ___________

 _____  ______________  ___________________________________  _________  ___________

_____  ______________  ___________________________________  _________  ___________           

Sub Total Material Cost: $____________________ Shipping Charges: $___________________

                                  Order Total: $ ___________________________U. S. Dollars

Note: If you have a list of required items, please attach a separate sheet.

 Shipping: Contact our office for a shipping quotation. Generally, these items are shipped by Priority Mail,

FedEx or UPS as required. Some larger orders will be shipped by motor freight and will be quoted on a

case by case basis. Most orders are directly factory drop shipped direct to your location.

Mail or E-Mail this form to:

Sandown Wireless, 19 Phillipswood Road, Sandown NH 03873

To Contact Sales, Call: 603-425-9876 If we are not in, please leave us detailed contact information.

It is highly recommended to E-Mail us for a quotation. E-mail: Sales

Personal Information will not be given to anyone else for any reason. If you feel more comfortable

having us contact you for CC info just make a note of that on the order form. Every effort is made to protect

The privacy of our customers.

Call: 603-425-9876 or E-mail Us. We will be happy to quote your requirements.

Special pricing is available from all our suppliers for volume sales.