Ventilaire™ Industries Ltd. Serving the Industry Since 1947

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Order Form - Fax to 212-941-1796

Product Description Model # Item Code Quantity Price
Shipping (Circle one:  UPS Ground, Next Day, 2nd Day, 3rd Day).  NYS residents will be charged 8.625% sales tax.

Customer Information - Circle if:     Business   or    Residence
Company Name:
City: State:                            Zip:
Phone: Fax:

Shipping Address - Check if same as above_____  Circle if: Business or Residence
Shipping Address:
City: State:                              Zip:
Phone: Fax:

Method of Payment
Please circle method of payment:
Check              Money Order          Credit Card (Visa and MasterCard only)
Please allow 10 business days for checks to clear.  Payment in full must be received prior to shipment in US dollars.  Make check payable to Ventilaire™ Industries Ltd.  Mail check or money orders to:Ventilaire™ Industries Ltd., PO Box692, New York, NY  10013
If ordering by credit card please fill in the following:
Name as it appears on credit card:
Account Number:_______-_______-_______-_______
Expiration Date:_______/_______
Type of Credit Card (circle one):              Visa                 MasterCard


©1999-2009 Ventilaire™ Industries Ltd.. All rights reserved
PO Box 692, New York, NY 10013-0692 | | Fax: (212) 941-1796 |
Serving the industry since 1947