(You may print out this page as a basic purchase order form and fax/ mail it to us.)

Purchase Order #___________________ Date:_____________

to: U.S. Avionics, Inc./ S.A.L.T. Superabrasives Lab/ 96 Burnham St., South Windsor, CT 06074

Fax: (860) 528-1116  

From:(company)________________________________________________

(contact name)     ________________________________________________

Address:              ________________________________________________

                            ________________________________________________

phone/fax/E-mail:  _______________________________________________

Item#:          Description:      Number of items ordered:       Unit price:         Total:

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Delivery/ shipping instructions: