Eureka 63 warranty Order Form

	The Eureka Company	3/03
		ORDER FORM
VACUUM CLEANERS	P.O. Box 2799
	Bloomington, IL 61702-2799
		(Not applicable in Canada)

S O L D

T O

Name

Address (street address needed for UPS)

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

S H I P

T O

Name

Address (street address needed for UPS)

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

To Order

__________________	Filter Assembly	39594	1.99
Model Number

By Phone	__________________	Hose Assembly	61808	5.49
		Large Brush	61809	2.49
HOURS:	Type
Call between 8 a.m.	__________________	Small Brush	61810	1.99
central standard time
	Serial Number
Monday through Friday.		Wand Package of 3	61853	3.99

By FAX		IMPORTANT:							Hose/Handle Assy	61854	7.99
1-309-823-5789		Be sure to include
									Floor Nozzle	61855	6.49
*En Mexico llame al	your model, type, and
5670-6169	serial numbers. These								Mesh Bag	61856	2.49
By Mail		numbers may be					To Answer Problems or Questions for U.S.A. and Canada call:			Total (prices subject to change without notice)
		found on the rating						1-800-282-2886*
Simply fill out this				plate.		8 a.m. - 7:30 p.m. (CST) Monday - Friday and 10 a.m. - 6:30 p.m. (CST) Saturday				Tax (add state and local taxes as required by law)
Order Form.
Please be sure to		Method of Payment (No C.O.D.s)								Postage and Handling Charge (Within the U.S.A.) $5.50
include day			Check or money order (payable to The Eureka Company). Do not send currency.
and evening											TOTAL ENCLOSED
phone numbers.			Visa (16 digits)		DiscoverCard (15 digits) MasterCard (13 digits)				American Express (15 digits)
ON-LINE
www.eureka.com
		Acct. number							Expiration date
								_____________________________________________			© 2003 White Consolidated Ltd.
72871
								1
								-
							and	800
								-
					4:45
								438
							p	-
					.			7352*

	m
	.
	,
Signature
(Full
name
as
shown
on		Genuine
account)
		Eureka
	Strap
		Parts

	Part
61812
	No
	.
	Qty
	.
.	Price
3

49
	(USD)

Printed

inTotal

China