Electric Boat Corporation's Fairwater Store Order Form

FAIRWATER STORE ORDER FORM
(Print it, complete it, and mail it)

Description:

Size:

Color:

Quantity:

Unit Price:

Total Price:

___ Check or money order enclosed
(Payable to Electric Boat Corp.)

___ Visa or Master Card (Circle one)
Account #: __________________________
Expiration Date: ______________________

Print Name: ____________________________
Signature: _____________________________
Address: ______________________________
City: _________________________________
State, Zip Code: ________________________
Daytime Phone: ( ) ____-__________________
Evening Phone: ( ) ____-__________________
Email Address: _________________________

SUB-TOTAL:
Add 6% Sales Tax: (CT Residents Only)
SHIPPING & HANDLING:	$ 6.00
TOTAL AMOUNT:

Ship To: (No Post Office Boxes, we ship UPS)

Name:_________________________________
(Please print name)
Address:_______________________________
City:__________________________________
State, Zip Code:_________________________

Send all orders to:
Electric Boat Corporation
Attn: Fairwater Store
75 Eastern Point Road
Groton, CT 06340

Click here to view/download this order form in Adobe(tm) PDF format.