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Print, Complete and Mail or Fax this Order Form. We will e-mail you within
24hrs to confirm received orders.
Genie Remotes & Accessories Order Form
E-Z UP Garage Doors, Genie Remotes & Accessories, PO
Box 495, Elkin, NC 28621
1-877-656-3432 -- 1-336-902-0511 -- PHONE/FAX: 1-336-835-9966 --
PRODUCT
ORDER FORM
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Ship to:
Name:
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Bill to: (If different
than "Ship To")
Name:
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| Address: |
Address: |
| City, State, Zip: |
City, State, Zip: |
| Phone Number:
( . . .) |
Phone: (. . .) |
| E-mail Address: |
E-mail Address: |
Item
Number
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Description
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Price
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Quantity
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Total
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Product Total:
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NC residents
add 6.5% Tax:
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Shipping:$1.50 per item
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TOTAL DUE:
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Method of Payment
_____Visa
_____MasterCard
_____Check
Make
Checks payable to:
E-Z UP Garage Doors
Card number:____________________
exp. Date:___/___
Cardholder's Signature:
_______________________________
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Methods of Ordering:
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via Mail:
send form to: E-Z UP Garage Doors, Genie Remotes & Accessories, PO Box 495, Elkin, NC 28621
Phone us: 1-877-656-3432
toll Free
Fax form to: 1-336-835-9966
Order online via paypal: www.members.tripod.com/ezupdoors/genieproducts
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