Order Form

ORDER FORM . . . . . . . . . . Date ____________________
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To: Electronic Specialists, Inc
75 Middlesex Avenue, P.O. Box 389
Natick, Massachusetts 01760, USA
Phone 508-655-1532 / Toll Free 800-225-4876 / Fax 508-653-0268
http://www.elect-spec.com / e-mail esp@elect-spec.com
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Ship To: *** Please print or type.
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Name______________________________________________________
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Address ___________________________________________________
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City/State __________________________________________________
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Mail Code / Country ______________e-mail ______________________
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Phone ____________________________________________________
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PLEASE SHIP THE FOLLOWING MERCHANDISE:
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QTY / ITEM / PRICE / TOTAL
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_____________________________________________________________
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_____________________________________________________________
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_____________________________________________________________
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PAYMENT: US & Canada :::: Credit Card :: ____ VISA ____ MASTERCARD ____ AM EXPRESS
____ PAYPAL <> ALL OTHERS: WIRE FUND TRANSFER
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Number ______________________________________________________
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Expiration Date ________________________________________________
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Name on Card _________________________________________________
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Address on Card _______________________________________________
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PRINT OUT THIS PAGE, FILL IN REQUESTED ITEMS and FAX to 508-653-0268
Or, For e-mail
In "EDIT" Chose "Select All" - or - Highlight entire form; COPY and PASTE into e-mail
Overwrite lines as needed and ..... hit "Send" .........THANK YOU

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