At-Home Services
Parts & Supplies Order Form
Date_________________________________
Name________________________________
Company Name________________________
Shipping Address_______________________
_____________________________________
Daytime Phone_________________________
Email Address_________________________
Do not fill in, At-Home Services use only.
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Inventory
Availability Yes No
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New Mexico Residents Only, Add 7%
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Orders $10.00 or less, $5.00 Shipping & Handling
Orders $10.00-$35.00, $7.00 Shipping & Handling
Orders over $40.00, Free Shipping!
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Send Check/MoneyOrder
In this Amount To The Address Below
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