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Replacement Parts Order Form
Send Orders To: Magnadyne Corporation We Accept Checks, Money Orders, Visa and Master Card
ATTN: Consumer Parts Sales Make Checks Payable to: Magnadyne Corporation
P.O. Box 5365
Carson, CA 90749-5365
SHIP TO: (No P.O. Boxes)
LAST NAME FIRSTNAME INITIAL
STREET ADDRESS (IF PAYING WITH A CREDIT CARD, YOUR BILLING ADDRESS IS REQUIRED)
CITY STATE ZIP CODE
DAY TIME PHONE NUMBER
CREDIT CARD INFORMATION:
CARD TYPE:
Ⅺ VISA Ⅺ MASTER CARD
CARD NUMBER EXPIRATION MONTH YEAR
NAME AS IT APPEARS EXACTLY ON YOUR CREDIT CARD
Part # Description Qty. Price Each TOTAL
Sales Subtotal = ________ . ______
California Residents Add Sales Tax = ________ . ______
Shipping and Handling (See Chart) = ________ . ______
TOTAL = ________ . ______
No C.O.D.’s
On regular orders please allow 4-5 weeks for delivery. Please give a shipping address where this order
may be delivered between the hours of 9 A.M. and 5 P.M. weekdays. If UPS is unable to deliver, your order will be
returned and additional shipping charges will be required.
Shipping and Handling
Subtotal + Tax Add
Up to $20.00 $5.00
20.01 to 30.00 5.95
30.01 to 45.00 6.50
45.01 to 70.00 6.95
Over 70.01 7.95
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