Product Order Form

Aluminum Brazing Rod

To Order by Credit Card using Paypal

Click Here

To Order by Mail, Phone or Fax:

Complete this form and print out using the print button on your browser

Mail or Fax this completed form to:

Mid-Am Marketing
3144 Hwy 159
Nortonville, Kansas 66060

Fax: 913-886-2747

Or Phone in Your Order at 913-886-2747

Name:
Company Name:

Address:

City: State:
Zip:

Telephone:

E-Mail Address:

Product Description	Quantity	Price	Extended Price (Quantity X Price Each)
HTS-735 II 1 Package ( 25 Rods)		$59.95
HTS-735 II 2 Packages (50 Rods)		$100.00
HTS-735 II 10 Packages (each package containing 25 Rods)		$450.00
Shipping and Handling $7.00 10 Packages add $63.00
Tax (Kansas Residents add 7.25%)
Total Enclosed (Check or Cashier's Check)

Please provide the following information for Credit Card Orders:

Visa Mastercard Discover

Card Number

Expiration Date

CVV2 Code
3 Digit code found on the back of your credit card

Questions? Please Contact us via e-mail
Midammarketing@yahoo.com
or Call our office at 913-886-2747

Home Contact Us Testimonials Demo Frequently Asked Questions MSDS