Anderson Innovations, Inc.
212 Dawson Street
Homer, Louisiana, 71040
Phone: 318-927-3934


MAIL ORDER FORM

INSTRUCTIONS:
This form is intended for check or money orders only. Credit card orders must be placed using our website at http://www.powerwedge.net. To submit a mail order, please complete and send this form, along with check or money order, to the above address. Checks or money orders should be made payable to "Anderson Innovations, Inc". PLEASE NOTE: Personal check orders will be subject to a 2-4 day waiting period to verify sufficient funds exist for payment before the order is shipped.

SHIPPING INFORMATION:

Name (First & Last):  
Company Name:  
Email Address:  
Address:  
 
City/State/Zip:  
Day Phone:  
Evening Phone:  
Questions/Comments:

 

 

ORDER INFORMATION:

Item Name Price Quantity

Totals
Power Wedge 1000 $12.00 each    
       
Delivery Charge (Shipping & Handling): $5.00
SubTotal:  
Louisiana Residents add 4% sales tax to SubTotal:  
Grand Total:  

Thank you for your order!