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Untitled Document

To Order by Fax or Mail

Complete and fax this form to 610-323-6269
Or Mail To: The Eastwood Company - 263 Shoemaker Road - Pottstown, PA 19464
Or complete the Microsoft Word order form and mail, fax or e-mail it to Eastwood.

Step 1 - Contact Information

Billing Address:
Name_______________________________
Street_______________________________
City_________________________________
State________________________________
Zip/Postal Code______________________
Country_____________________________
Daytime Phone #_____________________
E-mail Address_______________________

Ship To Address, if different (for non USPS shipping, a street address is required
- only United States Postal Service will deliver to PO boxes)

Name_______________________________
Street_______________________________
City_________________________________
State_______________________________
Zip/Postal Code_______________________
Country_____________________________


Step 2 - Products

Quantity Item # Description Price Each Item Total
         
         
         
         
         
         
         
         
         
         
         
         
         
Subtotal
 


Step 3- Shipping, Tax, and Payment

Product Subtotal from above _____________________

Shipping Charges (See shipping chart here) _________________
Hawaii, Alaska, and Foreign Orders: Please call 610-323-2200 for a shipping quote.

Orders shipping to Pennsylvania addresses add 6% Sales Tax ______________

Total Payment ______________

Payment Method

Visa___ MasterCard___ Discover___ AmEx___ Check or Money Order Enclosed________
Credit Card #________ - __________ - __________ - ___________
Expiration Date__________ / __________

Signature___________________________________________________________



Orders containing hazardous items (item numbers ending in "Z" or "ZP")
can only be shipped via Ground (to the Lower 48 United States) or Purolator (to Canada). We cannot ship Z or ZP items outside of the Lower 48 United States or Canada.