Sandown Wireless Order Form

Mail To: P.O. Box 564, East Hampstead, NH 03826

UPS and FedEx: 19 Phillipswood Road, Sandown, NH 03873

FAX To: 603-887-2117, Office: 603-974-0725

Print Page & Please Print Clearly, All Required Information   (MS Word Version)

           Sold To: (credit Card Billing Address)                         Ship To: (Final Destination)

Name: __________________________________________  Name: ________________________________________

Address: _______________________________________  Address: _______________________________________

City: __________________State: ____ Zip:___________  City: ___________________State: ____Zip:__________

Telephone: __________________________ Fax: _______________________ e-mail: _________________________

Check Enclosed  ____    Money Order Enclosed ____     Credit Card Order ____

Purchase Order Number: (______________)  Master Card: ___  Visa: ___  Discover: ___

Card Number: _______________________________________________________________

Exp. Date: __________________ Name On Card: __________________________________

Signature (Required if using Credit Card) ________________________________________

Returns: Full Refund Offered for 30 days if not satisfied with Supplied Products. Items must be

Returned as new, unused parts. We will make every effort to supply the correct parts for your use.

Item Manufacturer, if known: ________________________________

*Please Supply Exact O.E.M Equipment Model and Item P/N if you have it.

*Model: ___________________________ *OEM P/N # ______________________________

Qty---------Part Number-----------------Description---------------------Price Each----Item Total

_____  ______________  ___________________________________  _________  ___________

_____  ______________  ___________________________________  _________  ___________

_____  ______________  ___________________________________  _________  ___________

_____  ______________  ___________________________________  _________  ___________ 

See Next Page

Sub Total Material Cost: $____________________ Shipping Charges: $___________________

Order Total: $ ___________________________U. S. Dollars

 Shipping: Contact our office for a shipping quotation. Generally, these items are shipped by Priority Mail, FedEx

 or UPS as required. Some larger orders will be shipped by motor freight and will be quoted on a case by case basis.

 Most orders are directly factory drop shipped to your location but some export items must be handled through this local office.

Mail or Fax This Form To:

Sandown Wireless, P.O. Box 564, East Hampstead, NH 03826

Or Fax To: 603-887-2117

To Contact Sales, Call: 603-548-0125 (Ask for Keith Clark)

E-mail: Sales

Personal Information will not be given to anyone else for any reason. If you feel more comfortable

Calling in this order directly to Sandown Wireless Sales, please do so. Every effort is made to protect

The privacy of our customers. That is why we ask that you mail or Fax us this information. Never give

Credit Card information to unsecured Internet servers.

Dealers, Volume Customers & Government Accounts: Please call for pricing.

Call: 603-548-0125 or Fax: 603-887-2117. We will be happy to quote your requirements.

Special pricing is available from all our suppliers for volume sales.