Elsie Manufacturing - Order Form
600 N. Maple Street, Waterloo, IN 46793-9547 USA
www.elsiemfg.com — email: — fax 1-800-538-4164

Ordering Information
 Home Page
E-mail:


Ordering Information
Please print carefully
Company Name
Ordered By
Address
City/State
Zip
Phone Number
FAX or e-mail (optional)
P.O. Number (optional)
[    ] Alternate Delivery Address (work address, etc - where post office delivers)
Name
Address
City/State
Payment Information    -    please print carefully
Note Method of Payment
[    ] Check or Money Order (Payable to Elsie Manufacturing)
[    ] Cash
[    ] Credit Card: MasterCard, Visa, or Discover
Card #:
Card Verification # (On the back of your credit card, the last three digits of code in your signature area):
Expiration Date (MM/YR):
Product Information use product tables on the appropriate product page to fill out
Fusible Product 1 Ordered
Product Name    Temperature Needed            °F
Quantity    Price Each based on Quantity
 $
Total Amount for Fusible Material 1 $
Fusible Product 2 Ordered
Product Name    Temperature Needed             °F
Quantity    Price Each based on Quantity
 $
Total Amount for Fusible Material 2 $
Certification Needed     ($25.00 at time of purchase, $50.00 if ordered after production run) $
Tax        (or Tax Exempt #)   
Shipping Charge         (Call Toll Free +1 800-538-4163 for shipping quote) $
Total Enclosed                (minimum of $20.00 purchased required) $

Copyright 2010, Elsie Manufacturing Fusible Links