CUSTOMER INFORMATION:  Please Print
Your Name:
Phone Number:
Business Number:            
Cell Number:
Fax Number:  
E-Mail :                

SHIPPING ADDRESS:  Please Print
Ship To:
Street/Delivery Address:
City/District:                 
State/Province:
Zip/Postal Code:   
Country:           

Credit Card

16 Digit Credit Card Number

Expiration Date

3 Digit Verification (from back of card)

 MasterCard
 Visa/Visa Debit

_ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _

_ _ / _ _

(Optional)  _ _ _

QTY

NEI No.  /No of Cav.  (EX. 226A, 2cav)

DESCRIPTION (Ex. .412-300-GC)

UNIT PRICE

TOTAL
         
         
         
         
         
         
         

NOTES:  Instructions, questions, comments:

SUBTOTAL

  

SALES TAX
(Texas Residents – add 8.25%)

  

General Shipping Fees
(subject to adjustment)
US: $10.00/ up
INTERNATIONAL: $18.00/up
SHIPPING & HANDLING

  

International Fees (if applicable)

  

TOTAL

  

We will contact you to confirm receipt of your order, provide you with shipping cost and answer any questions that you may have.

 

Credit Card Authorization – Signature Required To Process Your Credit Card Payment  By my signature below, I attest that I have the lawful right to use this credit card for this purchase. I hereby authorize and grant NEI Handtools the right to place a one-time charge against this credit card for items on this order including shipping. I understand the total billable amount will include shipping charges and that NEI will determine these when the order is processed and will advise me via telephone, email fax or postal mail of said charges in advance of making the one-time charge against the acct.

NEI Order Form:
Revised 01/2008

                         Authorized by                                                                           Date