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AUTHORIZED APPLIANCE PARTS
P.O. BOX 2799, BLOOMINGTON, IL 61702-2799
BY MAIL: Simply fill out th is form and mail to address above. Please include day an d even in g ph one numbers
S
O
NAME
L
D
ADDRESS ( street address needed for UPS)
T
O
CITY
DAY TIME PHONE
FAX
IM PORTANT: Be sure to in clude your model, type, and serial number. These numbers may be found on the ratin g plate.
MODEL NUMBER: ____________________
ACCESSORIES/ TOOLS:
Uph olstery Nozzle with Bristles
Uph olstery Nozzle with Sponge
Hose Assembly
MISCELLANEOUS PARTS:
Brush Roll
Belt
Clean Water Solution Tank
Tan k Cap
Recovery Tank
Filter Package ( Reservoir & Basket Filters)
Carpet/ Floor Suction Cover
Rotor Kn ob
Boot Seal with Plun ger
Rear Wheel Replacement Kit ( wheels, axles, clips)
Meth od of Payment:
Check or Money Order ( payable to Authorized Appliance Parts)
Signature ( full name as sh own on acct.) _____________________________________________
STATE
ZIP
EVENING PHONE
E-MAIL
TY PE: ____________
_
Exp. Date:
Mon th
Y ear
TO ORDER BY PHONE, PLEASE CALL:
1-877-207-0923 between 7 a.m. and 8 p.m.
Central Standard Time, Monday - Friday
or FAX to 1-309-823-5789.
S
H
NAME
I
P
ADDRESS ( street address n eeded for UPS)
T
O
CITY
DAY TIME PHONE
FAX
SERIAL NUMBER: ______________________
Part Number
Qty.
61754
61755
61758
61759
61760
61761
61762
61763
61764
61765
61766
61756
61757
TOTAL
( prices subject to ch an ge with out n otice)
TAX
( add state tax & local taxes as required by law)
POSTAGE & HANDLING CHARGE
TOTAL
( please n o cash or C.O.D.s)
STATE
ZIP
EVENING PHONE
E-MAIL
Price ( USD)
Total
7.99
8.49
33.99
10.99
1.99
17.99
1.49
29.99
2.49
5.49
1.99
.99
3.99
$5.50
( with in U.S.A.)
Prin ted in U.S.A.
8/ 01
71727
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