Order Form

To order, please fill out this form, use your browser's Print button to print out this page, and fax it to 508-647-8185 or mail it with your check payable to Performatek to:

Performatek
P.O. Box 1096
Sherborn, MA 01770

 

Quantity Performatek
Part Number
Description Price Total
       
   

Subtotal:

   

Massachusetts Residents Add 5% Sales Tax:

To the shipping charges
from the table to the right,
 add any "Additional
Shipping" charges shown
 in the Price Lists
 for certain heavy items.

Subtotal Shipping Charge
$0.01 - 9.99 $4.50
$10.00 - 49.99 $6.50
$50.00 - 99.99 $9.50
$100.00 - 199.99  $12.50
$200.00 and over $15.50

Shipping:






   

Grand Total:

       

Payment method:

Money Order Visa
Cashier Check MasterCard
Certified Check Discover
Personal Check Diner's Club

Credit Card Number:

Expiration Date:

Name:
Address:
City, State, Zip:
Telephone (H):
Telephone (W):
Email:
Signature: ____________________________________