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Order form, Total enclosed, By mail – Eureka 1040 Series User Manual

Page 11

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72553

72552

72575-355N

61126

72571

71915-119N

72568

14.99

.99

4.99

2.09

12.99

6.99

8.99

Cloth Dust Bag

Motor Filter

Crevice Wand

Dusting Brush

Hose Assembly

Tool Tray

Supply Cord

Name

Address (street address needed for UPS)

City

State

Zip

Telephone

(Day)

(Eve)

(Fax)

TOTAL ENCLOSED

VACUUM CLEANERS

Name

Address (street address needed for UPS)

City

State

Zip

Telephone

(Day)

(Eve)

(Fax)

S

O

L

D

T

O

S
H

I

P

T

O

72635

© 2002 White Consolidated Ltd.

Printed in China

$5.50

Genuine Eureka Bags and Filters

Accessories/Tools

The Eureka Company
P.O. Box 2799
Bloomington, IL 61702-2799

Part No.

Qty.

Price (USD)

Total

ORDER FORM

12/02

(Not applicable in Canada)

IMPORTANT:

Be sure to include

your model, type,

and serial numbers.

These numbers

may be found on

the rating plate.

Model Number:

Type:

Serial Number:

To Order

By Phone

1-800-

438-7352*

HOURS:

Call between 8 a.m.

and 4:45 p.m.,

central standard time

Monday through Friday.

By FAX

1-309-

823-5789

To Answer Problems

or Questions for U.S.A.

and Canada call:

1-800-282-2886*

8 a.m. - 7:30 p.m.

(CST)

Monday - Friday and

10 a.m. - 6:30 p.m.

(CST)

Saturday

*En Mexico llame al

5670-6169

By Mail

Simply fill out

this Order Form.

Please be sure to

include day

and evening

phone numbers.

ON-LINE

www.eureka.com

Method of payment (no C.O.D. orders)

Check or money order

(payable to The Eureka Company). Do not send currency.

Visa (16 digits)

DiscoverCard (15 digits)

MasterCard (13 digits)

Amer. Express (15 digits)

Acct. number

Expiration Date

Signature

(full name as shown on acct.)

Postage & Handling Charge

(within U.S.A.)

Tax

(add state tax & local taxes as required by law)

Total

(prices subject to change without notice)