FD PARTS ORDER FORM

  DIRECTIONS:
  Please provide the following information in the proper spaces.
  Print this form and mail or fax to:
  Firedragon Enterprises, 608 Moose Hill Road, Leicester, MA 01524
 
Fax to: 508-421-3477  
  We do NOT accept forms sent by e-MAIL. Your data is secure and not stored anywhere.

First Name Last Name
Organization
Mailing Address Orders are sent by US Mail
City State/Province Zip/Postal Code
Work Phone FAX
E-mail @

BILLING

Credit Card

   We accept Visa and MasterCard only!
Cardholder Name
Card Number --- Expiration Date -

NOTE

If different than Mailing Address Billing Address of Credit Card holder   
Billing Zip of Credit Card holder

 Please provide the following ordering information:

QTY

DESCRIPTION PRICE - Each Weight
pounds
  201 - M-E-D Adapt-A-Stat $70.00 .5
  220 - Firedragon FB Filter Adapter $10.00 .5
  221 - Firedragon 1A25A Filter Adapter $5.00 .5
  222 - Firedragon 2A700 Filter Adapter   $6.00 .5
 233 - Floating Suction Pickup $70.00 1.5

Total of Parts $  

Total Weight

S & H Charges $  

TOTAL $ 

The following Shipping & Handling Charges will apply to all orders effective October 1, 2008. 

Weight
(Total Package)
Cost for total package
0 to 2 pounds $6.00
2 to 4 pounds $10.00
4 to 6 pounds $14.00
6 to 8 pounds $16.00
8 to 10 pounds $18.00
10 to 14 pounds $23.00
14 to 18 pounds $25.00
over 18 pounds Please call us

 You will receive a credit card slip with your order. We do not invoice. 
 We do accept checks and money orders.

  All parts pricing is in US Funds.
  Tool pricing includes USPS Priority Mail shipping!
  Please allow 1-6 weeks for delivery.
 
We accept part orders from the US only due to postal regulations.
  Orders to Alaska will have a $5.00 surcharge added. 

 Submittal of this order assures that buyer is aware that all of the material is for use by a properly qualified and if required licensed person. 

 Read our store policy by clicking here. 

Pricing is subject to change without notice and we reserve the right to decline older order forms.
Copyright © 1999-2008 FIREDRAGON PUBLICATIONS All rights reserved.
Revised: November 04, 2008