Woodwiz^® Splitter Printable Parts Order Form 

For VISA or Mastercard, checks or money orders, please print this page, fill out and snail mail to:

Easy Motion Inc.
P.O. Box 1285
Vestal, NY  13850

We ship via UPS or USPS to any continental USA destination.
Name___________________________________
Address ___________________________________(No PO Box please)
City______________________ State_____ Zip________
Daytime Phone______________________________
Email address:_______________________________

ITEM	PRICE	QUANT.	TOTAL
1. GRIP	$ 5.00	_______	_______
2. HAMMER	$20.00	_______	_______
3. HANDLE *	$25.00	_______	_______
4. ROLL PIN	$ 2.00	_______	_______
5. RET. RING	$ 3.00	_______	_______
6. POCKET WASHER	$ 4.00	_______	_______
7. SPRING	$ 5.00	_______	_______
8. SPLIT. TIP	$44.00	_______	_______
Sub Total			_______
New York State Tax if NYS resident (multiply by .0825)			_______
TOTAL ORDER			_______

* Handle includes assembled Pocket Washer, Spring and Roll Pin.

Enclose CHECK or MONEY ORDER payable to: Easy Motion Inc. OR:
Charge my (check one): ___VISA ___Mastercard (Minimum Charge $10.00)
Issuing Bank: ____________________________
Name on card: _____________________________
Card number: ____________________________
Expiration Date:____________________________