E-Z Spread N' Lift Printable Order Form

E-Z Spread n' Lift
Order Form - E-Z Lift Products
To order by phone (215) 322-2099 or fax this form (215) 322-1066
by mail...
E-Z Spread N' Lift Industries 1815 Buck Road, Feasterville, PA 19053 U.S.A.

Sold To :

PO #

Ship To : (if different)

Co Name (if applicable) :	Co Name (if applicable) :
Name :	Name :
Address :	Address :
City :	City :
State/Zip Code :	State/Zip Code :
Daytime Phone :	Daytime Phone :
Fax :	Fax :
E-mail :	E-mail :

Qty.	Description	Price (ea.)	Total
	E-Z TV Lift	1,495.00
	E-Z Lift 12" Model	895.00
	E-Z Lift 22" Model	1,095.00
	E-Z Tool	950.00
	Extension Tube Assembly	95.00
	E-Z Tool Carrying Bag	45.00

Add $55 for shipping to the price of the E-Z Lift, E-Z TV Lift, and E-Z Tool. Add $25 for shipping to the price of the extension tubes and carrying bag.

PAID BY : (Check One)	Credit Card Info (if applicable)
[ ] Check	Name on Card :	Total Amount	$
[ ] Money Order	Card # :	CVV2 #:
[ ] Master Card	Expiration Date :	PA Add 6% Tax	$
[ ] Visa Card	Signature	GRAND TOTAL	$

Prices are subject to change without notice.