Pillar Hand Held Sealer Order Form

PLEASE READ:
This online form is to make it easier for you to get us the information about what you would like to order. The actual processing and confirmation of the order will be sent to you by fax or in the mail. Please note that we only ask for the last four digits of a credit card number should you choose to purchase with credit card. We will ask for your complete credit card number separately for security.

Return to Pillar's Home Page.
 
Corporate Headquarters:
Pillar Technologies, an ITW Company
475 Industrial Drive
PO Box 110
Hartland WI 53029-0110		 Toll Free: 1-888-pillar-6
Phn: 262-912-7200
Fax: 262-912-7272
Bill To
Name
Company
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Telephone
Fax

Note: If using a credit card, the billing address above must be the billing address shown on your credit card statement.
Ship To
Name
Company
Address 1
Address 2
City
State/Province
ZIP/Postal Code
Country
Telephone
Fax
Payment
Method Check   American Express   VISA    MasterCard
Credit Card (Partial)   (Please enter the LAST FOUR credit card digits ONLY.)
Expiration Date
Name on Card
Terms

Full payment prior to shipping. We will request your entire credit card number after you submit this form. View Conditions of Sale

Order Information
Part
Number		 Product
Description
Order
Qty
Price
Each
Total Price
Shipping &
Handling
CB10693-5 120 V AC Power Supply & Small Coil
$3795.00 $85.00 ea.
CB10693-6 120 V AC Power Supply & Large Coil
$3795.00 $85.00 ea.
CB10693-7 240 V AC Power Supply & Small Coil
$3795.00 $85.00 ea.
CB10693-8 240 V AC Power Supply & Large Coil
$3795.00 $85.00 ea.
BB10720-2 Additional Small Coil (12-70 mm)
$1395.00 $50.00 ea.
BB10720-3 Additional Large Coil (63-120 mm)
$1395.00 $50.00 ea.
CB10693-4 Additional 120 V AC Power Supply only
$2400.00 $70.00 ea.
CB10693-1 Additional 240 V AC Power Supply Only
$2400.00 $70.00 ea.
Comments
 Shipping & Handling
Merchandise Total
Sales Tax (Enter local tax rate)
Example: 5% enter as .05
* Check here if tax exempt
Estimated Grand Total
Your Email Address   
If you were referred by a representative, please list here:
(Contact name / Company)

           

* If tax exempt, a copy of your sales exempt certificate will be required. Pillar Technologies will verify your tax rate and grand total.