Polly Heaters Order Form

Print out this form and mail it with your check or money order to the address listed below.

Part Number	Price Each	Quantity	Price
PH110	$35.00
PH200	$30.00
PH300	$21.00
PH400	$39.00
PH15	$8.00
		Sub Total:
		*Shipping:
		Total Price:

*Shipping and Handling is $9.25 for first kit, $4.95 for each additional kit. Accessories are 1.95 each.

Name: 
Address: <
Address: 
City:  State: Zip Code: 

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Polly Heaters, Inc.

9409 Schiller Blvd.

Franklin Park, Il 60131

Phone : (847)455-8654       Fax : (847)455-8710

E-Mail :  order@pollyheaters.com