Martin pellet stove repair order form

Martin Industries Pellet Stove PCB Order Form
(Valid for 10 days from submission)

Shipping Address	Shipping Method
First Name: M.I. Last Name : Address Line1: Address Line2: City: State: Zip Code: Day Time Phone #: E-mail:	UPS Ground $12 UPS 2 day $Cost UPS Overnight $Cost Billing Method Visa MasterCard American Express Money Order Check (Hold 10 days)
Billing Address
First Name: M.I. Last Name : Address Line1: Address Line2: City: State: Zip Code:	# units ordered $269 each plus shipping If using a credit card, please call 1-800-598-6904 to submit account number and expiration date after sending form

IP ADDRESS WILL BE RECORDED WHEN FORM IS SUBMITTED!