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PSEP Mail Order Form
 

Please print and complete the form below.

Your Name:

Name:_______________________________
Address:_____________________________________
City State Zip:_________________________________               
Country:_____________________________________
Phone #:_____________________________

 QTY          Item #                    Description                          Item Price       Total Items
  ___       _________     ________________________      ________       ________  
  ___       _________     ________________________      ________       ________
  ___       _________     ________________________      ________       ________
  ___       _________     ________________________      ________       ________ 
  ___       _________     ________________________      ________       ________
  ___       _________     ________________________      ________       ________
  ___       _________     ________________________      ________       ________
  ___       _________     ________________________      ________       ________
  ___       _________     ________________________      ________       ________ 
  ___       _________     ________________________      ________       ________
  ___       _________     ________________________      ________       ________
  ___       _________     ________________________      ________       ________
  ___       _________     ________________________      ________       ________

Sub Total:                                                             _______________
-Discount: 5% off orders if over $300.00               _______________
Shipping and handling, (circle one)                          $7.95 Ground, 24.95 2 day, 49.95 Next Day
Grand Total:                                                          _______________

Payment Method (circle one)   MONEY ORDER,     Visa, Mastercard, Discover, American Express

Credit Card Billing Address: (only if using credit card)
Name:_________________________________
Address:_____________________________________
City State Zip:________________________________

Credit Card Account Number:______________________________
Exp Date: ______________         
CVV:    ______________       
 

Please send completed form and payments "unless credit card" to:
PATS SMALL ENGINE PLUS
20912 HWY 65 NE
EAST BETHEL, MN 55011