Print this page, fill out this form and mail it with your payment to

Hancy Mfg. Co. 5324 Pheasant Lane, Montague, CA 96064 or fax to (530) 459-0528 Please make checks payable to Hancy Mfg.Thank You!

Ship Order to: (please print clearly)

Name___________________________________________

Address__________________________________________

City____________________St______Zip_______________

Telephone (optional) _________________________ (used to give updates of order status)

e-mail (optional)_____________________________________ (used to give updates of order status)

Product # Item Quantity Price Extension
         
         
         
         
         
         
         
         
         
         

All orders are carefully and quickly packed at our distribution center to assure a prompt and timely delivery.

Subtotal  
CA sales Tax (.0775) (California residents only)  
Shipping $4.60
Total  

                                             Please make checks payable to Hancy Mfg.