Please use this form for ordering via FAX, or you can fill it out and mail it in also if you like. FAX # 813-634-3400.

Eclectic-ware FAX Ordering Sheet. Please print this page for your use.

No fax machine? You can use your computer as a fax.  The mail order page contains a text block you can copy easily with your mouse. Paste that text into your word processing software. Select Print from the File menu and select your FAX printing software from the list of printers. Faxing comes straight to Eclectic-ware. No one but us sees your credit card info.
And we DO NOT sell your customer information to anyone! Fax this page to (813) 634-3400.

Name:

Phone:

FAX:

Address:

City:

State:

Zip:

E-mail:

Country:

AMX,VS,MC,Disc: ___ ___ ___ ___-___ ___ ___ ___-___ ___ ___ ___-___ ___ ___ ___

Exp date: ______/____

Comments:

CVC #

Add'tl info: (billing address, name on credit card, etc.)

Qty

Part # (if available)

Description - finish info

Additional info if any

Be sure to include your e-mail address above if faxing or mailing. (Fax & e-mail submissions received faster)
If mailing, mail to: Eclectic-ware, 3110 Turkey Walk Lane, Wimauma, FL 33598

Thank you for your order. A return FAX or e-mail (preferred) confirming your order will be sent shortly. (1-3 days)

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