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Order Form

Do you want this piece of equipment or parts for it?

______ Equipment            ______ Parts Only

Brand ____________________________________________

Model #  ______________  Type/Spec. # ______________ Serial # ______________

Shipping Address: Name: ______________________________
                             Street: ______________________________
                                City: _______________ State _____ Zip ____________
              E-Mail Address: ________________________________________

Billing and shipping address must be the same.

Billing Info: ___ Master Card        ___ Visa         ___ Discover Card
acct # __________________________________
expiration ______/______

No refunds.

Fax to (865) 938-3102

Mail To: Powell Power Equipment, Inc.
              7145 Clinton Hwy.
              Powell, TN 37849