Fentek Industries, Inc. -- Order Form
1042 N. Main Street, Cottonwood, AZ 86326
Serving our Customers for 22 Years

All information entered on this Form is Securely Encrypted

To place an order via our Secure Encrypted Server simply complete this form and click on the Submit Button.
To order by phone call 928-639-0161 or 800-639-0710 Monday - Friday 8am to 5pm Arizona MST Time.
To order by Fax or Mail print the form, Fax to 928-639-0551 or Mail to 1042 N. Main, Cottonwood, AZ 86326.

ORDER INFORMATION:

Quantity Part No. Description **Price Total
Total Order Value:
Shipping Method (Ground unless otherwise requested):
Applicable Shipping Charges will be added to your order (Click Here):
Shipments to Arizona wil be charged Sales Tax of 9.35%

BILLING INFORMATION:
*Required fields
Payment Method: Visa  MasterCard American Express
  Check Money Order (Payable to: Fentek Industries, Inc., Mail to: 1042 N. Main St., Cottonwood, AZ 86326)
*Credit Card Number: *Expiration Date: / *Card Verification Code:
*800 phone# on back of card:
*Name on Credit Card:
*Billing Address:
Suite/Apt/Floor#:
*City: *State: *Postal Code:
*Telephone: *e-mail:

SHIP TO: (If same as BILL-TO leave fields blank)

Name/Company:
Attention:
Street Address:
Suite/Apt/Floor#:
City: State: Postal Code:
Country: Providence:
Telephone: e-mail:

Please verify the accuracy of All information Submitted. (Note: Shipping carriers charge an additional $13.00
for an incorrect shipping address, which will be charged to the customer).

**Unit Prices are subject to change without notice. You will be notified before your order is accepted if a price is incorrect.


If you agree to all terms and conditions including our Returns/Warranty Policy, Click:

Please wait for an order acknowledgement. This could take up to one minute.

You will receive a separate order confirmation with a copy of your Sales Order or Invoice via e-mail within 24 hours
during regular business hours: Monday - Friday 8am - 5pm Arizona MST time.

If you have any questions regarding your order, please E-mail custsvc@fentek-ind.com and reference the name of the company
or individual the product is shipping to.

Thank you for your order with Fentek Industries, Inc.
www.Fentek-Ind.com