Pitrone & Associates Fax Order Form

C-72 Watchman's clock

Print and Fax to: 215.674.9338

or mail to:

Pitrone & Associates

P O Box 711

Hatboro, PA 19040

Any questions call 215.956.9797 9:00AM to 4:30PM EST Monday - Friday

Billing Information

Name:__________________________________

Company:_______________________________

Address:________________________________

City:________________________State:______

Country:___________ZipCode:_____________

Phone Number:__________________________

Fax Number:____________________________

E-Mail:________________________________

Shipping Information

Name:__________________________________

Company:_______________________________

Address:________________________________

City:________________________State:______

Country:___________ZipCode:_____________

Phone Number:__________________________

Fax Number:____________________________

E-Mail:________________________________

C-72 Watchman's clock (s)...Quantity Ordered_______Price Each $295.00 Total_________

Station Box & Key(s)........Quantity Ordered_______Price Each $20.00 Total ___________

Box of charts(s).................Quantity Ordered_______Price Each $20.00 Total ___________

Shipping (flat rate continental U.S.A shipments)______________________________$10.00

PA State 6% Sales Tax (PA SHIPMENTS ONLY) ___________________Total_____________
Charge to my: [MasterCard]____[Visa]____[Discover-Novus]____[American Express]______

Cardholder Name:_________________________________________________

Card Number:_____________________________________________________

Exp Date:_________________

Signature:________________________________________________________

Date:_________________

Click here to return to main products page.