ToolSurge.COM - Pro Tools for Pro Mechanics

FAX/Mail Order Form - Print and FAX Order to ToolSurge.com FAX# 717-502-1988
or, Mail To: ToolSurge.com, P.O. Box 535, Dillsburg, PA 17019
We ship to the continental U.S., Hawaii and Alaska. We do NOT ship internationally and due to strict goverment regulations we do NOT ship to APO or FPO addresses.

Quantity
Part Number
 Description
Price
       
       
       
       
       
       
   
Sub Total:  
 
Pennsylvania Sales Tax:  
 
Shipping Cost (calculate with online shopping cart):  
 
Total:  
 

Payment Method:
_____ Visa
 _____ Mastercard
_____ Amex
_____ Discover
_____ Money Order/Certified Check/Company Check
Phone # of Bank issuing card (on back of card):

Credit Card #:____________/____________/____________/____________   Expires: ____ /____ Security Code:_______ (Visa/MC/Disc 3 digit on back of card; Amex 4 digit on front)
Please Print Name exactly as it appears on card:  

Billing Address:
(address where you receive credit card statements)

  
 
 
U.S. Shipping Address:
(if different from above)
Note: We do not ship outside of the United States and we do not ship to APO/FPO Addresses.		  
 
  
E-mail Address (required):
Daytime Phone Number (required):

Signature Authorizing Credit Card Purchase (required):_______________________________________________________________
Thank you for your order!
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