Request for Order

Name:*
Company:*
Address:
City:
State/Province:
Postal/Zip Code:
Country
Phone:
Fax:
E-Mail:*

How do you want us to contact you?

Regular Mail

Phone

Fax

E-mail

Tell us a little about your company? *

Manufacturer

Wholesale Distributor

End User

ITEM #	QUANTITY	OUR PART #	DESCRIPTION
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May we contact you by phone if we have any questions?	Yes
Have you ever received parts from us before?	Yes
If yes, what is your account number?

Any message or special instructions?

* - These fields must be filled out otherwise we can not process your request

Phone 718-542-8144.

Fax your order to 800-221-3932. (Outside the US dial 718-893-2758.)

E-mail your order

All orders receive a faxed Confirmation.

Please state your preferred shipper, if any. Dayton Industries will be happy to recommend a carrier if you have no preference.

Call, fax or email special requests.

TERMS and CONDITIONS

Terms are net thirty days, F.O.B. our plant Bronx, NY.
Prices seldom vary from those listed; however, we reserve the right to change prices without notice.
We will not accept any return item without prior written approval.
All dimensions are in inches unless otherwise noted.
Our warranty is limited. We shall not be liable for any injury, loss or damage, direct or consequential, arising out of the use or inability to use any item sold by us. Our only obligation, in lieu of any warranties, expressed or implied, is to replace any item proved to be defective. Before using, the user should determine the suitability of the product for its intended use and the user assumes all risk in connection therewith.