Order Form

Please fill out this form, print it, and fax it to us at (414)425-8363

Item Price/ea Quantity Line Total
05 Trainer US$ 485 US$
205 Trainer US$ 1865 US$
Terminator I/O Trainer US$ 2172 US$
Analog Simulator US$ 279 US$
Sub-Total US$
Shipping US$
Total (excluding tax) US$
  * indicates required information
*Your Name
Your Title
Company Name
*Address
*City *State: *Zip
   
*Phone Number
Fax Number
*E-Mail
Method of Payment: Check (please send check along with order form to address below)
 
 
  Purchase Order  
  PO Number:
  (Purchase Orders must be paid in full before shipping)
 
 
  VISA     MC     AMEX
  Number:
  Expiration:
  Signature:
   
*Comments/Questions
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InterConnecting Automation Inc.
12154 N Ridge Trail
Hales Corners, WI 53130

Voice: (414) 425-8348   Fax: (414) 425-8363