E Manufacturing

4177 Riddle By-Pass Road, Riddle, Oregon, 97469
(541) 874-2137 ; FAX (541) 874-3107

Please provide the following information: * = Required Information

Company Name
* Name First * Name Last
* Address
* City * State * Zip
* Country
* Area Code & Phone
* Email Address

Please fill in the following product information:

* Order# * Description * Quantity * Price Each * Total
* Subtotal for Merchandise
* (E&L Standard Shipping isVia. U.S. Postal Service Priority Mail)
Shipping: U.S. & Canada $13.00 for the first $50.00, from $51.00 to $100.00=$15.00
(Add $5.00 for each additional $100.00)
Foreign Orders Shipping;Will be charged actual Shipping Charges.
Call or e-mail for exact charges.
* Total Amount This Order
* Cardholders Name

If Cardholder Name is the same as above please enter X.
* Billing Address
* Billing Zip
* Card Number
* Expiration Date
* CVV No. Whats This?

C.V.V. Number on your Credit Card
Visa, Master Card and Discover Cards: Last 3 digits of the Card Number imprinted in the Signature Strip on the BACK of the card.
American Express: 4 digit number above and to the right of the Card Number on the FRONT of the card.
Copyright 2022 E&L Manufacturing Inc.

Secure Online Order Form
If you do not wish to submit this form online, you may fax or send it by mail. Complete the form and print two copies. Retain a copy for your records. You may also print the blank form and complete it at a later date or call us direct at 541-874-2137.