Name:   ________________________________________________________

Address:   ______________________________________________________

City, State, & Zip Code:    __________________________________________

Credit Card # :   ______________________________  Exp. Date : _________

Check one :     ___ Visa        ___ Master Card        ___ Discover

Shipping Address :  (if different from address above)

Address:   ______________________________________________________

City, State, & Zip Code:    __________________________________________

Specify method of Shipping :   (next day air, 2 day air, ground):

  _______________________________________________________________

Equipment & Parts Needed :    (add a separate page if needed)

  ________________________________________________________________

  ________________________________________________________________

  ________________________________________________________________

  ________________________________________________________________

  ________________________________________________________________

Mail this Form to:

Phone or Fax us at:

E-Mail us at: 

D&W Lawn Equipment
Post Office Box 858
La Marque, Texas 77568

(409) 938-0271 (voice)
(409) 938-4512 (fax)

dwlawn@sbcglobal.net