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TO PURCHASE PHONOGRAPH GRILLS  click here for different form

TO PURCHASE OTHER ITEMS:  Please provide the following information so that we can send off your purchase.  You can fill this form in here on line or just print it out and mail it. Send us a check or money order to confirm the order.

Your item will be well packaged and shipped to you insured.  See product page or call for shipping costs. 

IMPORTANT: Use the TAB KEY to move to the next box and shift TAB to go back.  If you hit enter use your back key and start again.

Name
Title   (If applicable)
Company (If applicable)
Address
E-mail
Phone
             Items Purchasing                              Quantity      Price

Item 1:     
Item 2:     
Item 3:     
Item 4:     
                                                                                            Subtotal:   
                                                                                          Shipping:*  
                                                                                         Insurance:** 
                                                                                                 Total:    

Notes or special shipping instructions:

How did you find our site?

Type validation text here as it appears in red 3405LAK

Submit Request when finished.     

Send Check or Money Order to confirm your order to:

Tom Rutkowski, 3405 Lakeshore, Lexington, MI  48450

CompanyPhone, Fax:  810-359-2430

CompanyEmail
 

Information Request Form...  Click here
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