Order Form

ORDER INFORMATION FORM Print and FAX
Fax # 1-860-669-6982

Voice 1-800-235-2628

Click here to print this Page

Boat Name:___________________________________________

Today Date:___________________________________________

Delivery Date:___________________________________________

Customers Name:___________________________________________

Merchandise
(Any Questions Please call)

Product Number listed on the price list	Product Description	Dimensions (if needed)	Quantity	Total
________	____________________________	______________	______	_____
________	_____________________________	______________	______	_____
_______	_____________________________	______________	______	______

Billing Address:

Shipping Address

METHOD OF PAYMENT
(Please, no cash)

______MONEY ORDER

_______VISA

_______MASTERCARD

______AMERICAN EXPRESS

______DISCOVERY CARD

FOR YOUR PROTECTION, ALL CREDIT CARD ORDERS ARE VERIFIED !

ISSUING BANK	______________________________
YOUR SIGNATURE	______________________________
CARD NUMBER	______________________________
EXPIRATION DATE	______________________________
S.E.C. Code on the back of your card 3 numbers or letters	______________

FOR YOUR PROTECTION, ALL CREDIT CARD ORDERS ARE VERIFIED !

YOUR SIGNATURE _________________________________________

Voice 1-800-235-2628 Fax 1-860-669-6982

Voice 1-800-235-2628 or 1-860-669-6637 Fax 1-860-669-6982
41 Commerce Street, Clinton Connecticut USA 06413