At-Home Services
Parts & Supplies Order Form
Date_________________________________

Name________________________________

Company Name________________________

Shipping Address_______________________

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Daytime Phone_________________________

Email Address_________________________
Do not fill in, At-Home Services use only.
Date
Received
Inventory
Availability          Yes          No
Date
Processed
Date
Shipped
Quantity
Item Description
Part #
Price
Total
         
         
         
         
         
         
         
         
         
         
         
 
Total
 
New Mexico Residents Only, Add 6.875%
Sales Tax
 
Orders $10.00 or less, $4.00 Shipping & Handling
Orders $10.00-$35.00, $5.00 Shipping & Handling
Orders over $35.00, Free Shipping!
Shipping
 
Send Check/MoneyOrder
In this Amount To The Address Below
Grand Total
 
At-Home Services
PMB 124, 3301-R Coors NW
Albuquerque NM
87120-1229

877-853-1446 (Toll Free)
505-620-5760
at-home-services@comcast.net
Special Instructions

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Please properly package, insure, & ship your order (along with this form) to:

At-Home Services
PMB 124, 3301-R Coors Rd. NW
Albuquerque NM 87120-1229

Upon completion of work, you will receive email (or phone) notification detailing the total cost of your order and payment options. All
orders will be shipped promptly upon receipt of payment.
Phone & Email-505-255-6030/at-home-services@comcast.net