| ORDER FORM |
|
HOBBY FIREWORKS L.L.C. |
| DESCRIPTION |
Price Each |
QTY |
TOTAL |
|
17020 Hoover Road |
| Star Rolling Machine 110 Volt |
$249.00 |
|
|
|
Sterling, IL 61081 |
| Star Rolling Machine 220 Volt |
$299.00 |
|
|
|
(815) 499-0806 |
| Extra Drum for Star Rolling Machine |
$30.00 |
|
|
|
fax (775) 256 3808 |
| Ball Mill Small 110 Volt |
$205.00 |
|
|
|
www.hobbyfireworks.com |
| Ball Mill Small 220 Volt |
$249.00 |
|
|
|
hobfir@essex1.com |
| Media "Small Mill" |
$60.00 |
|
|
|
SHIP TO: |
|
| Extra Jar "Small Mill" |
$25.00 |
|
|
|
ADDRESS: |
|
| Ball Mill Large 110 Volt |
$289.00 |
|
|
|
|
|
| Media "Large Mill" |
$65.00 |
|
|
|
City/State: |
|
| Extra Jar "Large Mill" |
$50.00 |
|
|
|
Zip: |
|
| Small Rocket Press |
$175.00 |
|
|
|
PHONE #: |
|
| Large Rocket Press |
$219.00 |
|
|
|
E-MAIL: |
|
| Powered Press |
$393.00 |
|
|
|
|
|
|
|
|
| Rocket
Press Blast Shield 1/4" |
|
$35.00 |
|
|
|
|
|
| Rocket
Press Blast Shield 1/2" |
|
$60.00 |
|
|
|
|
|
| Rocket
Press Blast Shield 3/4" |
|
$85.00 |
|
|
|
|
|
| Star Size Separator 110 Volt |
$179.00 |
|
|
|
| Star Size Separator 220 Volt |
$229.00 |
|
|
|
Method of
Payment (Choose One) |
| SUBTOTAL |
|
|
  
|
Check or Money Order |
|
| CASHIER'S CHECK DISCOUNT - LESS $10.00 |
|
|
|
Visa |
|
|
| IL RESIDENTS ADD 6.25% SALES TAX |
|
|
|
Mastercard |
|
|
| SHIPPING (US ONLY) |
|
|
Credit Card #: |
|
|
|
| Overseas shipping visit our website, call or e-mail. |
|
|
|
| Star Rolling Machine 110 Volt |
$20.00 |
|
|
|
Expiration Date: |
|
|
|
| Star Rolling Machine 220 Volt |
CALL |
|
|
|
|
|
|
|
|
| Extra Drum for Star Rolling Machine |
$5.00 |
|
|
|
| Ball Mill Small 110 Volt |
$20.00 |
|
|
|
|
FOR OFFICAL USE ONLY: |
|
| Ball Mill Small 220 Volt |
CALL |
|
|
|
Date Received: |
|
|
|
| Media "Small Mill" |
$20.00 |
|
|
|
Date Shipped: |
|
|
|
| Extra Jar "Small Mill" |
$5.00 |
|
|
|
Authorization #: |
|
|
|
| Ball Mill Large 110 Volt |
$40.00 |
|
|
|
|
|
|
|
|
| Media "Large Mill" |
$25.00 |
|
|
|
|
|
|
|
|
| Extra Jar "Large Mill" |
$5.00 |
|
|
|
|
|
|
|
|
| Small Rocket Press |
$20.00 |
|
|
|
|
|
|
|
|
| Large Rocket Press |
$25.00 |
|
|
|
|
|
|
|
|
| Powered Press |
$35.00 |
|
|
|
|
|
|
|
|
| Rocket
Press Blast Shield 1/4" |
|
$5.00 |
|
|
|
|
|
|
|
|
| Rocket
Press Blast Shield 1/2" |
|
$10.00 |
|
|
|
|
|
|
|
|
| Rocket
Press Blast Shield 3/4" |
|
$15.00 |
|
|
|
|
|
|
|
|
| Star Size Separator 110 Volt |
$20.00 |
|
|
|
|
|
|
|
|
| Star Size Separator 220 Volt |
CALL |
|
|
|
|
|
|
|
|
| |
Grand Total |
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| |
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| BUYERS STATEMENT OF
LIABILITY RELEASE (MUST BE SIGNED) |
|
| 1. I understand and certify that I am at
least 21 years of age or older. |
|
| 2. I will observe and obey all federal,
state, county, city and local laws and regulations. |
|
| 3. I agree to hold Hobby Fireworks L.L.C. and
all it's employees harmless for any and all claims, alleged or proven,
resulting |
|
| in any way from the sale, use or misuse
of any item or items purchased. |
|
|
| 4. I agree and understand all terms in this
statement. |
|
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| Signature: |
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|
Date: |
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