OFF-LINE ORDER FORM

Please print this pageand fill it out. Then fax or mail your order to us. You can also call your order into us. For faster and safer service, use our secure severs @ www.tirechain.com.

tirechains.com
115 Haynes
Johnstown PA 15901

Phone:814-248-3375

Fax:(814) 495-4526
email: [email protected]
www.tirechain.com

Today's Date:
P.O. #
(if applicable)
Sold to (name & address):
Ship to (if different than sold to):
Product # Description Tire Size Quantity Price per unit Total

Subtotal:

PA Residents add 6% Sales Tax:

Shipping Charges (please call):

TOTAL:

Money Order
Name on Card:
Credit Card #
Expires:
Signature:
credit card security code
Check #:

Credit Card (form to right):



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