A-1 Engineering
SPECIAL OFFER ORDER FORM
Print Out This Form, Complete It & Fax Your Local Dealer
Or Fax our 24-hour order line at 604-792-2219
Tel: 604-792-2216   Website: www.workstop.com

Promotional Code: Introductory Offer Offer expires: Limited Time Offer
BILL TO:SHIP TO:
Company:____________________________Company:____________________________
 ____________________________ ____________________________
Attn:____________________________Attn:____________________________
Address:____________________________Address:____________________________
City:____________________________City:____________________________
State/Prov:____________________________State/Prov:____________________________
Zip/Postal:____________________________Zip/Postal:____________________________
Phone:____________________________Phone:____________________________
Fax:____________________________Fax:____________________________
E-mail:____________________________E-mail:____________________________
ORDER PO#FED TAX ID#
ITEM#DESCRIPTIONQTYREGULAR PRICESPECIAL OFFERAMOUNT
P6-5A6" Stopper (Purple)______$89.00$75.00 USD_________.___
R8-5A8" Stopper (Red)______$119.00$99.00 USD_________.___
Y10-5A10" Stopper (Yellow)______$185.00$165.00 USD_________.___
P6-DMB6" Detachable Magnetic Bar______$39.00$29.00 USD_________.___
R8-DMB8" Detachable Magnetic Bar______$39.00$29.00 USD_________.___
P6-TN6" T-Nut (specify)________________$5.00$4.00 USD_________.___
R8-TN8" T-Nut (specify)________________$5.00$4.00 USD_________.___
Y10-TN10" T-Nut (specify)_______________$5.00$4.00 USD_________.___
T-Nut Sizes
All Stoppers Come with 9/16" T-Nut
Additional Sizes Available 1/2", 5/8", 11/16"
SUB TOTAL:_________.___
S & H:_________.___
TOTAL:_________.___
Shipping & Handling
$10.00 for 1st Stopper, $3.00 Each Additional
UPS Regular Ground or Priority Mail
 CREDIT CARD ORDERS (complete)Credit Card (circle one) VISA    MASTERCARD
Credit Card Number:___________________________Expiry Date:______________________
Card Holder Name:____________________________Signature:________________________

 CREDIT ORDERS (request): Please fax a Company credit reference sheet. Account terms Net 30

ORDER CONFIRMATION: We will confirm your order via fax upon processing.

THANK YOU FOR YOUR BUSINESS