Carbide Depot International Order Form
(Please print from your Internet Browser & Fax to 205-942-2896 in the US)

Quantity Carbide Depot Item # / Part # Unit Price Ext. Price
                                                             
       
       
                                                             
                                                             
                                                             
       

Total Value of Order (not including Shipping):

 

Add International Shipping Charge $50.00 US / or provide your UPS account #

 

Total Value of Order (including Shipping):

 


Billing Information:



First Name: _____________________________

Last Name: _____________________________

Company: ______________________________

Address: _______________________________

City: __________________________________

State/Province: __________________________

Postal Code: ____________________________

Country: _______________________________

Phone: ________________________________

Fax: __________________________________

Email: _________________________________

UPS account number: _____________________

 


Shipping Information:



First Name: _____________________________

Last Name: _____________________________

Company: ______________________________

Address: _______________________________

City: __________________________________

State/Province: __________________________

Postal Code: ____________________________

Country: _______________________________

Phone: ________________________________

Fax: __________________________________

Email: _________________________________

UPS account number: _____________________

 

Credit card to be charged (circle):  Visa     /     MasterCard     /     American Express     /     Discover

Card #: _________________________________         Exp. date: ____________

Name on Credit Card:  _________________________________