53
52
We
MUST
have this information to process your order:
Model Number (5 digits & 3 letters): ________________
Manufacture Date (mm/dd/yyyy): ___________________
Replacement Parts List
NOTE:
If requested color is not available, similar color will be
substituted.
Part Cost Quantity Total Cost
Locking Clip ................ $0.00 X _____ = $ ______________
Instructions ................. $0.00 X _____ = $ ______________
Merchandise Total
$
______________
Shipping and handling:
$
______________
Sales Tax
$
_______________
(Arizona, California, Georgia, Indiana, Missouri, South Carolina, and Texas residents
add applicable sales tax.)
Grand Total $ ________________
No shipping and handling on instructions for quantities under 6. Add $.50 for each
instruction over 6, then add applicable shipping and handling.
Up to $25.00 ....................... $5.95
$25.01 to $50.00 ................ $6.95
$50.01 to $75.00 ................ $8.95
$75.01 to $100.00 .............. $9.95
$100.01 to $150.00 ............ $10.95
$150.01 to $200.00 ............ $11.95
$200.01 and up ................. $13.95
Outside Continental USA $10.00
Fill Out For Credit Card
q
Visa
q
Mastercard
Card Exp. Date: ______________________________
Cardholder’s Name: __________________________
Card Number: _______________________________
Signature___________________________________
4358-5626A Rumi S1 Inst.indd 55-56
4358-5626A Rumi S1 Inst.indd 55-56
2/23/12 2:46 PM
2/23/12 2:46 PM
