Scanmix Corporation

PRINTABLE ORDER FORM

You can fax orders along with credit card information to 1-207-782-1914 or mail them along with check, money order or Visa/MasterCard to Scanmix Corporation, 36 Hogan Rd.., Lewiston, ME 04240. Call us at (207) 782-1885 or email us anytime.

Billing Address Shipping Address (if different)
Name: Name:
Address Address
City, ST, Zip: Phone:
email: Fax:
Model # Description Quantity Price Each Total Price
         
         
         
         
         
Subtotal  
Maine Tax 5%*  
Shipping*  
Total  

Custom Cast Personalized Heirloom Bells must be pre-paid ~ please allow 6 to 10 weeks for delivery

In capital block letters, please clearly indicate exact lettering below.  You can use a separate sheet, or the back to note special instructions or placement preferences. # Letters
   

Method of Payment:

Check or Money order Enclosed  
Credit Card: Visa_____ MasterCard _____ Name on Card
Card # Exp. Date
  Signature:

The following shipping charges will be added to your order shipped within the continental U.S.A.

Model #

Shipping

M304, M305 or bracket ordered alone

$ 8.00

M306, M307 & Candlesticks 

$ 10.00

M16

$ 19.00

M17

$ 22.00

M18

$ 24.00

M19

$ 29.00

M19.5 $125

When bells shipped within the state of Maine, we are required to charge a 5% sales tax.

Home | Price List | Back to How to Order Page