Order Form

Sandown Wireless Battery Order Form

19 Phillipswood Road, Sandown, NH 03873

Office: 603-425-9876 Fax: 603-887-2117 E-Mail Sales

Please Clearly Print All Required Information, If possible, enclose this form with your Dept. PO.

Sold To: (Credit Card Billing Address) Ship To: (Final destination)

Name:_______________________________________ Name:_____________________________________

Address:_____________________________________ Address:____________________________________

City: __________________State:____ Zip:_________ City: ___________________State:____Zip:_______

Telephone: ______________________ Fax: _____________________ e-mail: _________________________

Check Enclosed ___ Money Order Enclosed ___ Credit Card Order ___

Purchase Order Number: (______________) Master Card: ____ Visa: ____ Discover: ____

Card Number: __________________________________________________________________

Exp. Date:________Security Code: _____ Name On Card (Print): ________________________

Signature (Required if using Credit Card) ____________________________________________

Returns: Full Refund Offered for 30 days if not Satisfied with Supplied Products. Items must be

returned as new, unused parts. We will make every effort to supply the correct parts for your use.

Item Manufacturer, if known: _________________________________________________

Please Supply Exact O.E.M Equipment Model and Battery P/N if you have it!

*Model: ___________________________ *OEM Battery # ____________________________

Qty------Part Number-----------------Description-----------------------Price Each--Item Total

_____ ______________ ___________________________________ _________ ___________

(If you have an extensive list, please attach a note to this request with the details.)

Sub Total Material Cost: _______________________ Shipping: _________________________

Order Total: $ _______________________ U. S. Dollars

Shipping, Radio Battery Packs:

Add $10.50 for handling and shipping from 1 to 5 radio battery packs, in continental USA. Add $1.50 for

each additional radio battery pack after five. For all other locations, please call for a quote.

Shipping, Rebuilt TOOL Battery packs (To & from shop & back to you):

$12.50 for the first tool pack and add $5.00 for each additional pack, (USA lower 48 shipments only) up to

15.6 Volt packs. Over 15.6 Volt tool packs, $15.50 for the first pack and add $7.00 per pack after that. For

all other locations, please contact us for a shipping quote. For all new packs, please call for a quotation.

Payable in U.S.A. dollars only. Please see our warranty pages details. Shipping, depending on items is usually

with UPS or FedEx. Shipping for Medical, Computer, SLA & all other types will be quoted on request.

Mail or E-Mail this form to:

Sandown Wireless, 19 Phillipswood Road, Sandown, NH 03873

To leave a message for sales, call: 603-425-9876

E-mail: Sales (sales@criticalbattery.com) for the fastest response!

Personal Information will not be given to anyone else for any reason. If you feel more comfortable calling in

this order directly to Sandown Wireless Sales, please call us and leave a message with your contact

information. If you do not wish to put your CC info on this form, just note to call you where the form asks for

Credit Card information.

Dealers, Volume Customers (100+) Please E-mail or call for pricing.

Thank You For Considering Sandown Wireless, USA