Specifications

Adamson Industries Corp.
™
45 Research Drive
Haverhill,MA01832 1-800-232-0162
MAIL OR FAX ORDER FORM

NOTE:Ifyouhaveanyquestionsregardinghowtousethisorderblank,pleasecallAdamsonIndustriesat800-
232-0162or978-681-0370.Oursalesstaffwillassistyouwithanyquestionsyoumayhave.Ifyouareunsure
ofhowtocalculatecorrectshippingcharge,AdamsonIndustriessalesstaffcaneasilyhelpyougureoutcorrect
chargesbeforeyoumailorFAXyourorder.Ordersthatareincompleteorincorrectcouldbedelayedwhilewaiting
for customer contact or additional payment.
Sub-Total
Shipping
Oversize
Insurance 1.50 (Per Order)
TOTAL
YEAR MAKE MODEL
       
FEDERAL IDENTIFICATION # 04 3194481
SHIPPING CHARGES
Sub-TotalAmt. ..........Add Shipping & Handling
$
00.01-
$
60.00 ..................................
$
6.00
$
60.01-
$
100.00 ..................................
$
10.00
$
100.01-
$
130.00 ..................................
$
13.00
$
130.01-
$
160.00 ..................................
$
16.00
$
160.01-
$
200.00 ..................................
$
20.00
$
200.01-
$
250.00..................................
$
25.00
$
250.01-
$
300.00..................................
$
30.00
$
300.01-
$
400.00..................................
$
40.00
$
400.01-
$
500.00..................................
$
50.00
$
500.01-
$
600.00..................................
$
60.00
$
600.01 & Over ..............................
$
_________



Agency / Company
Address
     
Phone No. (area code)

Agency / Company
Address
     
Phone No. (area code)

 MasterCharge Visa
 PersonalCheck MoneyOrder Cashier’sCheck
Purchase Order No.
Charge Card No. Exp. Date
Name on Card (please print)
Cardholder’s Signature