Ewave Order Form

• Print this form, complete it and fax it to (972) 248-3646
• Or, cut-and-paste the form into your email program, complete it and email it to sales@electrowave.com
• Or, fill in the form, then call us at NNN-NNN-NNNN. Monday-though-Friday, 9am to 5pm Central (Dallas) time.

Billing Address:


Last Name:      ________________________
First Name:     ________________________
Street:         ________________________
City:           ________________________
State/Province: ________________________
Zip Code:       ________________________
Country:        ________________________
Telephone or Email in case of problem:
                ________________________


Shipping Address:


Last Name:      ________________________
First Name:     ________________________
Street:         ________________________
City:           ________________________
State/Province: ________________________
Zip Code:       ________________________
Country:        ________________________


Payment Information (mark one):
 ____ by personal check


 ____ by credit card:
      ____ VISA or ____ MasterCard
      Expiration Date ____________ (MM/YY)
      Cardholder Name ____________________
      Card Number     ____________________


Product Order:
  P/N        Description               Qty      Total $
  __________ _________________________ ________ __________
  __________ _________________________ ________ __________
  __________ _________________________ ________ __________
  __________ _________________________ ________ __________
  __________ _________________________ ________ __________
  __________ _________________________ ________ __________
  __________ _________________________ ________ __________
  __________ _________________________ ________ __________
  __________ _________________________ ________ __________
  __________ _________________________ ________ __________


  Shipping Cost                                 __________
  Sales Tax for Texas Residents                 __________
  Total                                         __________