Replacement Parts Order Form

Send Orders To: Magnadyne Corporation	We Accept Checks, Money Orders, Visa and Master Card
ATTN: Consumer Parts Sales	Make Checks Payable to: Magnadyne Corporation
P. O. Box 5365
Carson, CA 90749-5365

SHIP TO: (No P.O. Boxes)

LAST NAME

FIRST NAME

INITIAL

STREET ADDRESS (IF PAYING WITH A CREDIT CARD, YOUR BILLING ADDRESS IS REQUIRED)

CITY

STATE

ZIP CODE

DAYTIME PHONE NUMBER

CREDIT CARD INFORMATION:

CARD TYPE:

VISA

MASTER CARD

CARD NUMBER

EXP. MONTH

YEAR

NAME - EXACTLY AS IT APPEARS ON YOUR CREDIT CARD

Part #

Description

Qty.

Price Each

TOTAL

MV1020RM

Remote Control

$39.95

Shipping and Handling

Subtotal + Tax

Add

Subtotal = __ .

Up to $20.00

$5.00

California Residents Add Sales Tax = ________ . ______

20.01 to 30.00

5.95

30.01 to 45.00

6.50

Shipping and Handling (See Chart) = ________ . ______

45.01 to 70.00

6.95

Over 70.01

7.95

TOTAL = ________ . ______

No C.O.D.’s

On regular orders please allow 4-5 weeks for delivery. Please give a shipping address where this order

may be delivered between the hours of 9 a.m. and 5 p.m. weekdays. If UPS is unable to deliver, your order will be

returned and additional shipping charges will be required.