Printedform

Order Form

Date: ___/___/0_

Name:_________________________________________

BILL TO ADDRESS: (FOR CREDIT CARDS) SHIP TO ADDRESS:
______________________________ ____________________________

______________________________ ____________________________

Email:___________________________________

Fax: (___)____-________ Phone: (___)____-________

Payment:

[ ] Money Order, [ ] Check #______ [ ] Credit Card Card Authorization Form

#_____________________________________

Note: We will notify you upon receipt of your check!

We will ship within 24-48 hours, Monday through Friday.

(if we're unable to, we'll notify you as soon as possible).

Quan. Description/model Cost Ea. Total

_____ ____________________________________________ ____.___ ____.___

Sub-total ____.___

NJ residents add 7% sales tax ____.___

Total ____.___

PLEASE USE OUR CREDIT CARD AUTHOIZATION FORM AND FAX BACK TO US!

Please make check or money order payable to:

ALPHA WATER SYSTEMS INC

P.O. BOX 1210

MONTAGUE, N.J. 07827

PHONE 973-293-7856

FAX: 973-293-8056

Emergency Installation # 914-489-3068 7 Days!

EMAIL:ALPHASYS@WARWICK.NET