Georgia Avionics -- New/Used Equipment Order Form

Georgia Avionics Inc.

841B Ronald Wood Road

Winder, GA 30680

Voice Phone: 770-867-0002 _________Fax: 770-867-1212

You May Place Your Order By:

Phone
FAX (Fill in this form , print and FAX it to: 770-867-1212)
SUBMIT (Not Available at this time)---(Fill in this form and press 'Submit' button at bottom of form

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Name:

Address:

Address:

City:

State:

Zip Code:

Voice Phone:

FAX Phone:

e-Mail Address:

Please enter shipping information: (Only if different from Billing Information!)

Ship Name:

Ship Address:

Ship Address2:

Ship City:

State:

Zip Code:

Please enter the items that you desire to purchase:

Item

Qty

Part No./ Description

Price Each

1.-

2.-

3.-

4.-

5.-

New Price List

Used Price List

Note: Georgia Residents add 7 % Sales Tax. All items paid for in advance by Money Order or Certified Funds will be shipped prepaid by UPS ground. Special shipping by air is available at extra charge if desired.

Method of Payment:

Card Number: Expires:

Name on Card:

Shipping Method:

To Submit Order :

Erase Form :

Page Last Updated: 7/5/2007

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Name:
Address:
Address:
City:
State:
Zip Code:
Voice Phone:
FAX Phone:
e-Mail Address:

Ship Name:
Ship Address:
Ship Address2:
Ship City:
State:
Zip Code:

Item	Qty	Part No./ Description	Price Each
1.-
2.-
3.-
4.-
5.-