ORDER FORM ~ FOR MAIL OR FAX ORDERS ONLY ~ TO ORDER ONLINE, CLICK HERE. ORDER FORM Wetzler Clamp Company, Inc. P.O. Box 175 Mt. Bethel, PA  18343 FAX: PHONE: TOLL-FREE: E-MAIL: (570) 897-5891 (570) 897-7101 (800) 451-1852 sales@wetzler.com MAILING ADDRESS: Name: ________________________ Address: ________________________ ________________________ ________________________ SHIPPING ADDRESS: (if different) Name: _________________________ Address: _________________________ _________________________ _________________________ STOCK NO. QTY. ITEM DESCRIPTION PRICE EA. TOTAL                                                                                                     SPECIAL INSTRUCTIONS: MERCHANDISE TOTAL   PA customers, add 6% sales tax   TOTAL ENCLOSED   NOTE: Appropriate shipping charges will be added to your order. ORDERED BY: Name _______________________ Phone _______________________ Fax _______________________ Date _______________________ P.O. # _______________________ (if applicable)   Signature _______________________ METHOD OF PAYMENT(check one)   CREDIT CARD       CHECK        C.O.D. CREDIT CARD INFORMATION     MasterCard     Visa     American Express Card #: _____-_____-_____-_____ Exp. Date: ____/____