Order Form - Wetzler Clamp Co., Inc.

	Wetzler Clamp Company Inc. A division of Treacy Industries P.O. Box 175, Mt Bethel, PA 18343 1-(800) 451-1852 1-(570) 897-7101	ORDER FORM
		Please print and fill out this form. Fax to: 1-(570) 897-5891 Email: sales@wetzler.com

Mailing address:
Name:	____________________________
Address:	____________________________
	____________________________
	____________________________

Ship to: (If different from mailing address)
Name:	____________________________
Address:	____________________________
	____________________________
	____________________________

STOCK NO.	QUANTITY	ITEM DESCRIPTION	PRICE EACH	TOTAL










Where did you hear about our web site?		MERCHANDISE TOTAL:
		If from PA, add 6% sales tax:
		TOTAL ENCLOSED:
		*Appropriate shipping charges will be added to your order.

Ordered by:
Name:	____________________________
Phone:	____________________________
Fax:	____________________________
Date	____________________________
Purchase order # if applicable:	____________________________

METHOD OF PAYMENT (please check one)

C.O.D.

MasterCard

Visa

American Express

____________________________

Card Number

____________________________

Expiration Date

____________________________

Signature