Item	Description	Quantity	Price $
Name: Company:
Address:
City:	State:   Zip:
Telephone, and FAX:	Country:
E-mail: Shipping Address:
Credit.Card:	Visa AmExpress MasterCard   Card N:
Expiration :	Month  Year     Code 3 digit code from the back of the card VISA-MASTER  4 Digit AMEX front
	Thank You

 Items purchased online will be shipped via UPS ground. Estimated delivery within 7 to 10 business days.
 Please note that we DO NOT sell your email address or phone number to any other party.
  · The address you give must match the billing address of the credit card
  · We Can NOT deliver to PO Boxes! Sales tax will be added to your order if required by your state
  · International orders shipping & handling will be confirmed Via Email

You may order By Fax, or Mail , Print out this form with your Browser and send your order,
By Fax  561 892 0712 - By Mail or Pay by Check:
Electrodepot.  21218 St Andrews Blvd  508 -  Boca Raton, FL 33433
Check orders take two weeks to process.  Warranty