DockTester™ Electrical Integrity Tester
Printable Order Form
FAX credit card order to 1-360-681-6904 or mail with payment to ESC Products Corp., P.O. Box 520, Carlsborg, WA, USA 98324Home © 2001-2009 ESC Products Corporation
Name:
Shipping Address:
City:
State/Province: Zip/Postal Code:
Country: Telephone Number or Email:
Please specify cable length, e.g. DT2030-4 for a 4 foot input cable
Qty _____ DockTester™ DT2030-___ at $_________ each, total $____________
Qty _____ DockTester™ DT3050-___ at $_________ each, total $____________
Qty _____ DockTester™ DT5050-___ at $_________ each, total $____________
Qty _____ RP1 Reference Probe at $_________ each, total $____________
Total for order: $______________ Date of Order: ________________
State of Washington customers will be charged WA state sales tax at the proper tax rate for the destination of the product.
Shipping charges will be added at cost.
Method of Payment:
Credit Card Number Expiration Date: Name of cardholder (please print) Signature of cardholder:
If the name or address on the credit card is not the same as the shipping name and address, please complete the sections below.
Billing Name:
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