Electrolux Z7040 Order Form, Authorized Appliance Parts, Corona Wire, 61915, EF100, 49.99

09/02

S O L D

T O

AUTHORIZED APPLIANCE PARTS

P.O. Box 2799, Bloomington, IL 61702-2799

Name

Address (street address needed for UPS)

City	State	Zip
Telephone (Day)	(Eve)	(Fax)

S H I P

T O

ORDER FORM

(Not applicable in Canada)

Name

Address (street address needed for UPS)

City	State	Zip
Telephone (Day)	(Eve)	(Fax)

By Phone

1-800-

HOURS:

Call between 8 a.m.

and 4:45 p.m.

central standard time Monday through Friday

By FAX

1-309-823-5789

*En Mexico llame al

5670-6169

By MailSimply fill out this

Order Form.

Please be sure to

include day and evening phone numbers.

__________________
Model Number
__________________
Type			Corona Wire		61915	9.99
__________________
			Electrostatic Paper Filter		EF100	49.99
Serial Number
		IMPORTANT:	Carbon Filter		EF101	24.99
Be sure to include your model,
	type, and serial numbers.
	These numbers may be
	found on the rating plate.
	To Answer Problems or
	Questions for U.S.A. and
		Canada call:
1-800-282-2886*
	7 a.m. to 8 p.m. central standard
	time Monday through Saturday				Total (prices subject to change without notice)
	Method of Payment (No C.O.D.s)
					Tax (add state and local taxes as required by law)
		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)		Postage and Handling Charge (Within the U.S.A.)		$5.50
						TOTAL
	Acct. number			Expiration date
			_____________________________________________			© 2002 White Consolidated Ltd.

72584	438
		To
		Order
	-
	7352*

Signature (Full name as shown on account)

Printed in Sweden

Part

No

.

Qty

.

Price (USD)

Total