Woodwiz®Splitter Printable Order Form 

For VISA or Mastercard, checks or money orders:

Please print this page, fill out and mail to:

Easy Motion Inc.,
PO Box 1285
Vestal, NY 13850

Ordered by:
Name__________________________________________________
Address________________________________________________
City_________________________ State_____ Zip________
Daytime Phone___________________________________________
Email address:___________________________________________

Ship to:
Name__________________________________________________
Address______________________________(no P.O. Box please)
City_________________________ State_____ Zip________
Daytime Phone___________________________________________
Email address:____________________________________________

Shipping: NOTE: UPS will NOT ship to any PO Box address.
For all orders East of the Mississippi River, please add $13.00.
For all orders West of the Mississippi River, please add $15.00.
Washington, Oregon and California please add $18.00.
Canadian locations can be shipped Airmail Parcel Post for $30.00

Number of Splitters Ordered  _______
Cost of Splitter(s): $99.95 x quantity = $_______
Shipping (See above for exact shipping costs per unit) = $_______
New York State Tax 8%(if NYS resident $8.00 per unit) = $_______
Total Cost     $_______

Charge my (check one): ___VISA    ___Mastercard
Issuing Bank: ____________________________________
Name on card: ___________________________________
Card number: ____________________________________
Expiration Date:______________

OR:  Enclose CHECK or MONEY ORDER payable to:Easy Motion Inc.

Ten day money back guarantee.  One year warranty parts and labor.