MAQUINSAL        

            SEWING MACHINES SALES & SERVIVE                                 411 S.  MAIN ST

    SPECIALIST ON ALL KINDS OF ELECTRONICS                   SANTA ANA, CA 92701

                & REGULAR SEWING MACHINES                                        TEL (714) 568-0102

                                                                                                                FAX   (714) 568-1005

                                                                                                                                   Email -maquinsalco@sbcglobal.net

ORDER REQUEST FORM

To order parts, please fill out this form and send it to maquinsalco@sbcglobal.net or FAX to (714) 568-1005. You will be contacted by a parts specialist about your order when it is received.

*** REMINDER- Address is your shipping address. We will ship to the location you provide below

***There is a minimum of $30.00 for an order to be place (Shipping  and handling not included) for all parts orders. 

*Required Fields

*Company:__________________________________________________________

*Name:______________________________________________________________

*Telephone:______________________ FAX:_________________________ Email:______________________

*Address:_______________________________________________________________________________

*City:_____________________________ * State:___________ *Zip:______________________

List of Parts:

*Parts Number                                       *Description                                                                               *QTY

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PAYMENT/BILLING INFORMATION (SHIPPING CHARGES WILL BE CALCULATED AFTER QUANTITY AND ZIP CODE ARE ANALYZED)

Credit Card: Maquinsal Sewing Machine Co accepts Visa, Master card and American Express

[  ] Visa                              [  ] Master Card                         [  ] American Express

Account number:_______________________________________________Expiration Date:_____________

Credit Card Holder Name:__________________________________________________________________

Credit Card Holder Signature:_______________________________________________________________

Security Code:____________________________________________________________________________

Credit Card Billing Address (if different than shipping address)

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