Eureka 56, 54 warranty Order Form

The Eureka Company

2/01

ORDER FORM

P.O. Box 2799

Bloomington, IL 61702-2799

S

Name

Name

S

O

H

Address (street address needed for UPS)

Address (street address needed for UPS)

L

Canada)

I

D

City

in

State

Zip

P

City

State

Zip

T

T

O Telephone

(Day)

(Eve)

(Fax)

Telephone (Day)

(Eve)

(Fax)

O

applicable

__________________

Model Number

(Not

Motor Filter

61130

2.09

__________________

Type

Charger (240 volt) - model Z79

61229

6.99

__________________

Battery Pack - model 79

70685

13.29

Serial Number

IMPORTANT:

Total (prices subject to change without notice)

Be sure to include your

model, type, and serial

numbers. These

Tax (add state and local taxes as required by law)

numbers may be found

on the rating plate.

Postage and Handling Charge (Within the U.S.A.)

$3.75

Method of Payment (No C.O.D.s)

TOTAL

Check or money order (payable to The Eureka Company). Do not send currency.

Charge to my Visa (13/16 digits)

MasterCard (13 digits)

American Express (15 digits)

Questions call:

time

Acct. number

Expiration date

al

_____________________________________________

70695

blemsor andCanada

2886*282- standardcentral hroughSaturday

Printed in China & U.S.A.

xicollame 61690-