AUTHORIZED APPLIANCE PARTS
P.O. BOX 2799, BLOOMINGTON, IL 61702-2799
BY MAIL: Simply fill out this form and mail to address above. Please include day and evening phone numbers
S
O
NAME
L
D
ADDRESS (street address needed for UPS)
T
O
CITY
DAYTIME PHONE
FAX
IMPORTANT: Be sure to include your model, type, and serial number. These numbers may be found on the rating plate.
MODEL NUMBER: ____________________
ACCESSORIES/TOOLS:
EXTENSION WANDS
DUSTING BRUSH
CREVICE TOOL
STRETCH HOSE
DISPOSABLE PAPER BAGS, BELTS AND DELUXE ALLERGEN FILTERS MUST BE PURCHASED AT YOUR LOCAL WAL-MART STORE.
MISCELLANEOUS PARTS:
HEADLIGHT - package of 2
BRUSH ROLL
MOTOR FILTER
FRONT WHEEL - package of 2
REAR WHEEL - package of 2
UPPER CORD HOOK
HOSE RETAINER
FRONT COVER LATCH
REAR AIR TUBE
REAR AIR TUBE FASTENER - package of 2
ALLERGEN FILTER FRAME
ALLERGEN FILTER COVER
Method of Payment:
Check or Money Order (payable to Authorized Appliance Parts)
Signature (full name as shown on acct.) _____________________________________________
STATE
ZIP
EVENING PHONE
E-MAIL
TYPE: ____________
_
Exp. Date:
Month
Year
TO ORDER BY PHONE, PLEASE CALL:
1-877-207-0923 between 7 a.m. and 8 p.m.
Central Standard Time, Monday - Friday
or FAX to 1-309-823-5789.
S
H
NAME
I
P
ADDRESS (street address needed for UPS)
T
CITY
O
DAYTIME PHONE
FAX
SERIAL NUMBER: ______________________
Part Number
Qty.
61452-1
61453-1
61454-1
61440-1
61444-1
61445-1
61455-1
61446-1
61447-1
61456-1
61457-1
61458-1
61459-1
61448-1
61460-1
61461-1
TOTAL
(prices subject to change without notice)
TAX
(add state tax & local taxes as required by law)
POSTAGE & HANDLING CHARGE
TOTAL
(please no cash or C.O.D.s)
10/00
STATE
ZIP
EVENING PHONE
E-MAIL
Price (USD)
Total
2.99
2.59
1.99
7.99
1.59
15.89
.99
1.69
1.99
.99
.99
.99
4.99
1.29
1.99
2.99
$5.50
(within U.S.A.)
Printed in U.S.A.
71107