Ordering Page-Alexy Associates Ultrasonic Cleaners

Ordering Page

Please complete our ordering form. You may have us call you to take your credit card information, or you may mail or fax it to the address below.

First Name:
Last Name:
Company:
Phone:
Fax:
E-Mail Address
Shipping Address:
Shipping Address 2
City:
State:
Zip:
Payment Information: Please print this page and forward with payment to address/fax/email below.
Master Card:	Discover:	Visa:
Check/Money Order:	Purchase Order: (Hard copy and suitable credit rating required for purchase order option.)

Please Call Me For Credit Card Information:
Credit Card #: (Ex - xxxx xxxx xxxx xxxx )
Expiration Date: (Ex - 06/15/2003)
Additional Comments:

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Alexy Associates, Inc.
86 Jim Stephenson Rd.
Swan Lake, NY 12783
Phone: 845.482.3000
FAX: 845.482.3040
josephalexy@yahoo.com