02/02 | ORDERFORM | (NotapplicableinCanada) |
Name
Address (street address needed for UPS)
Zip
State
City
(Fax)
(Eve)
Telephone (Day)
Total |
|
|
|
Price(USD) | 2.09 | 5.09 | 1.99 |
Qty. |
|
|
|
PartNo. | 61811 | 61808 | 61809 |
Parts | Assembly | Assembly |
618101.79 | 618122.99 | Total(pricessubjecttochangewithoutnotice) | Tax(addstateandlocaltaxesasrequiredbylaw) |
|
| andCanadacall: | throughSaturday |
$5.50(WithintheU.S.A.) |
|
|
| WhiteConsolidatedIndustries,Inc. PrintedinChina |
TOTAL |
| |||
Charge |
|
| ©2002 | |
PostageandHandling |
|
|
|
|
|
| Express(15digits) |
| date |
|
| |||
| S H I P | T O | ||||
2799 |
|
|
| Zip |
| (Fax) |
|
|
|
| |||
TheEurekaCompany P.O.Box2799 Bloomington,IL61702- |
|
| forUPS) | State |
| (Eve) |
CLEANERS | SName |
| Address(streetaddressneeded | City |
| Telephone(Day) |
VACUUM |
|
|
|
|
| |
O L D | T O | |||||
|
|
|
|
|
|
|
|
| Eureka | Filter | Hose | LargeBrush | |
|
|
|
|
|
|
|
|
| Genuine |
|
|
|
|
__________________ | ModelNumber | __________________ | Type | __________________ | SerialNumber | ||||||||
ToOrder |
|
|
|
|
|
|
|
| ByPhone | HOURS: Callbetween8a.m. and4:45p.m. | centralstandardtime MondaythroughFriday. | ||
|
| ||||||||||||
|
|
|
|
|
|
|
| ||||||
|
|
|
|
|
|
|
| ||||||
|
|
|
|
|
|
|
| ||||||
|
|
|
|
|
|
|
| ||||||
SmallBrush | Strap |
| ProblemsorQuestionsforU.S.A. | 8p.m.centralstandardtimeMonday | ||
|
|
| ToAnswer |
|
| 7a.m.to |
IMPORTANT: Besuretoinclude | yourmodel,type,and | serialnumbers.These | numbersmaybe | foundontherating | plate. | |
ByFAX | *EnMexicollameal | ByMail |
|
| ||
|
| |||||
|
|
|
|
| ||
|
| EurekaCompany).Donotsendcurrency. | American |
|
| Expiration |
| _____________________________________________ | |
|
|
|
|
| |||||
|
|
|
|
| |||||
|
|
|
|
| |||||
|
|
|
|
| |||||
|
|
|
|
|
|
| |||
|
| MasterCard(13digits) |
|
|
|
| |||
|
|
|
|
|
| ||||
|
|
|
|
|
| ||||
|
|
|
|
|
| ||||
|
|
|
|
|
| ||||
|
|
|
|
|
| ||||
|
|
|
|
|
| ||||
|
| Checkormoneyorder(payabletoThe |
|
|
|
|
| Signature(Fullnameasshownonaccount) | |
MethodofPayment(NoC.O.D.s) |
| Visa(13/16digits) |
|
|
|
| |||
|
|
|
|
| |||||
|
|
|
|
| |||||
|
|
|
|
| |||||
|
|
|
|
| |||||
|
|
|
|
| |||||
|
|
|
|
| |||||
|
|
|
|
|
| ||||
| Chargetomy |
|
| Acct.number | www.eureka.com | ||||
|
|
| |||||||
|
|
| |||||||
|
|
| |||||||
|
|
| |||||||
|
|
|
|
|
| ||||
OrderForm. Pleasebesureto |
|
|
|
| |||||
Simplyfilloutthis | includeday | andevening phonenumbers. | 71891 | ||||||