ORDER FORM

Important: please read the Ordering Instructions page

VORTECH, Inc.
P O BOX 511 - W
Fallston, MD 21047 • USA

Your e-mail address: _______________________________________________

Your Name: ______________________________________________________

Address:_________________________________________________________

City: _____________________________________________________________

State / Province: _________________ Zip / Postal Code: ___________________

Country (if not USA) ___________________________________________

Phone: ___________________________  Fax: __________________________

Please send me (clearly print or type description and price of item)                

1. _____________________________________________ @ $____________

2. _____________________________________________ @ $____________

3. _____________________________________________ @ $____________

4. _____________________________________________ @ $____________

5. _____________________________________________ @ $____________

Crating Cost: (refer to listing) $ ___________

SUB-TOTAL $____________

Shipping Cost: (add only if this amount is prepaid) $____________

SALES TAX (Maryland residents only, add 6%) $____________

TOTAL $ ___________

Important: We can only accept U.S. credit card orders for Hot Specials and Engines. Credit card maximum: $500. Please read the Ordering Instructions page.

CARD TYPE (check one)  _____VISA    ____ MASTERCARD    ____AMEX    ____DISCOVER

CARD NUMBER: _______________________________________________

EXPIRATION DATE: (in the form mm/yyyy; such as, 08/2027): ___________________________

3-DIGIT SECURITY CODE (CVV): ________________

NAME APPEARING ON CARD: ________________________________________________

SIGNATURE OF CARD HOLDER:: _____________________________________________

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