Suspension Specialists - Fax/Mail Order Form

Suspension Specialists Fax/Mail Order Form

Suspension Specialists is offering you the option of charging your order to your Master Card, Visa Card or Discover Card. Or if you prefer, you can mail this form and enclose a check or money order.

This is by far the easiest payment plan we offer, If you wish to take advantage of this convenient payment option, please provide us with the information requested below.

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Bill To:		Ship To:	(if other than Bill To)
Name:	__________________________________	Company:	__________________________________
Address:	__________________________________	Address:	__________________________________
City:	__________________________________	City:	__________________________________
State:	__________________________________	State:	__________________________________
Zip:	__________________________________	Zip:	__________________________________
Attn:	__________________________________	Attn:	__________________________________
Phone:	__________________________________	Phone:	__________________________________

Qty	Item	General Description	Cost Ea.	Total
______	____________________	______________________________________	__________	__________
______	____________________	______________________________________	__________	__________
______	____________________	______________________________________	__________	__________
______	____________________	______________________________________	__________	__________
______	____________________	______________________________________	__________	__________
______	____________________	______________________________________	__________	__________
______	____________________	______________________________________	__________	__________
( Use the information supplied on our quotation to fill in the above fields )			Sub Total	__________
		Mass Residents add 5% Sales Tax	Tax	__________
	(circle one)	UPS Ground - UPS Blue - UPS Red	Shipping	__________
			Total	__________

Payment Type	(circle one)		Todays Date:	/ / 2000
MasterCard	Visa Card	Discover Card	Money Order	Check

I authorize Suspension Specialists to charge this purchase as indicated above to my credit card.
Card Number	__________-__________-__________-__________	Expires	_______
Signature	__________________________________________	Daytime Phone	________________

For your protection, Suspension Specialists reserves the right to confirm all credit card purchases.

Mail to: Suspension Specialists Co., Inc Fax To: 1-617-782-5667

P.O. Box 216 For inquiries regarding this order call:

Allston, Ma. 02134 1-800-649-0506

Mail to:	Suspension Specialists Co., Inc	Fax To: 1-617-782-5667
	P.O. Box 216	For inquiries regarding this order call:
	Allston, Ma. 02134	1-800-649-0506