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
* Shipping - US & Canada $8.00 for the first $50.00 - $10.00 for $50.01 to $100.00
(Add $4.00 for each additional $100.00)
Shipping - Foreign Orders will be charged actual Shipping Charges
For a Foreign Order Shipping Quote Call 1-541-874-2137
* Total Amount of 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.
© 2018, E&L Manufacturing. All Rights Reserved
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.

SPECIAL - If you would like to place an Order, Pay with a Postal Money Order and receive a 15% Discout Click Here...

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