Books & conference proceedings on
shot peening and blast cleaning

Fax Order Form, Page 2

Indicate quantity and price of each item you wish to order on the order form below.
Fax both payment information below and Book Order Form to:
Electronics Inc. at 1-574-256-5222

PAYMENT INFORMATION: Please type or print
Date:__________________________      
Name:_______________________________________________ Title:______________________________
Company or Organization:________________________________________________________________
Address:________________________________________________________________________
City:_______________________________________________  State:_______ Zip:_______________
Country:_______________________________________________
Telephone:_______________________________________________ Fax:_____________________________
e-mail:_______________________________________________
Total Cost (does not include shipping and handling)

$_______________

  

_____MasterCard _____Visa ____ American Express | Credit Card

#:___________________________________

Expiration Date: _________
Signature: ___________________________________________________________________________

Note: Shipping and handling extra