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Name:
Callsign:
Company:
Phone:	¤
Fax:
Address:	¤
City:
State:
ZIP Code:
Email Address:	¤ See Below

¤ Be sure these items are correct so we can properly ship your merchandise or contact you if necessary. Your E-address is not shared, sold, or published. Its only use is for communication between you and The Wireman, Inc.

A receipt for your order will be emailed to you as soon as possible. This email will also advise you if there will be a delay for any reason. Next, an invoice for the total cost of product and shipping will then be emailed to you. Online payments can be made securely by clicking on Payments here, or from The Wireman home page. If you prefer, you can safely supply your credit card data via phone at 800-727-9473 Monday through Friday from 8 AM to 4PM ET, or by fax to 864-895-5811. Normal shipping is via UPS Ground or USPS, using the lowest rate. Please advise any other or special shipping, if required.

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Product Order Work Sheet
Item Part #	Quantity	Description	Price	Total

Please enter any questions, comments or suggestions: