"Seal It" Order Form

Name:
Date:
Address:

City:

State:

Zip:
Telephone:

Please enter my order for:

"Seal It" Model A can seaming machine @ $1,325.00 each

  X   $1,325.00   = $
   (Quantity)                                                                                          

"Seal It" Model B can seaming machine @ $1,495.00 each

  X   $1,495.00   = $
   (Quantity)                                                                                          

                      Optional can size adapter kit @ $145.00 each size:
                                   _________     300 Size Can Adapter
                                    (Quantity)
                                               _________     401 Size Can Adapter
                                    (Quantity)
                                              _________      404 Size Can Adapter
                                    (Quantity)
   

    X $145.00  = $
         (Total Quantity)                                                                       

  Sub-Total      $

  Utah Residents add 6.85% Sales Tax       $

Shipping @ $60.00 per machine  X $60.00 = $
(Quantity)                                                                             

TOTAL       $

Payment Method: Check Enclosed
Visa or Mastercard.
Acct #
 EXP Date:

SIGNATURE       

Print Order Form Fill it out
Send or Fax to:

Heinhold Engineering & Machine Co., Inc.
Salt Lake City, UT 84104
801-886-1196   FAX 801-973-7620 E-Mail: heinhold1@hotmail.com
Toll Free: 1-800-262-4275

Or Fill it out online, and we will contact you via your email address