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Elsie Manufacturing – Order Form
600 N. Maple Street, Waterloo, IN 46793-9547
USA
www.elsiemfg.comemail: info@elsiemfg.com
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 carefullyNote 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 $25.00 purchased required) $

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