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    To Order by Fax or Mail

    Complete and fax this form to 610-323-6269
    Or Mail To: The Eastwood Company - 263 Shoemaker Road - Pottstown, PA 19464
    Or complete the Microsoft Word order form and mail, fax or e-mail it to Eastwood.

    Step 1 - Contact Information

    Billing Address:
    Name_______________________________
    Street_______________________________
    City_________________________________
    State________________________________
    Zip/Postal Code______________________
    Country_____________________________
    Daytime Phone #_____________________
    E-mail Address_______________________

    Ship To Address, if different (for non USPS shipping, a street address is required
    - only United States Postal Service will deliver to PO boxes)

    Name_______________________________
    Street_______________________________
    City_________________________________
    State_______________________________
    Zip/Postal Code_______________________
    Country_____________________________


    Step 2 - Products

    Quantity Item # Description Price Each Item Total
             
             
             
             
             
             
             
             
             
             
             
             
             
    Subtotal
     


    Step 3- Shipping, Tax, and Payment

    Product Subtotal from above _____________________

    Shipping Charges (See shipping chart here) _________________
    Hawaii, Alaska, and Foreign Orders: Please call 610-323-2200 for a shipping quote.

    Orders shipping to Pennsylvania addresses add 6% Sales Tax ______________

    Total Payment ______________

    Payment Method

    Visa___ MasterCard___ Discover___ AmEx___ Check or Money Order Enclosed________
    Credit Card #________ - __________ - __________ - ___________
    Expiration Date__________ / __________

    Signature___________________________________________________________



    Orders containing hazardous items (item numbers ending in "Z" or "ZP")
    can only be shipped via Ground (to the Lower 48 United States) or Purolator (to Canada). We cannot ship Z or ZP items outside of the Lower 48 United States or Canada.