FAX ORDER FORM


Please fill in ALL requested information. If the field indicates "CALL", please call CelticParts to continue the order.


First Name

Last Name

Company Name

Contact Email Address

Phone Number

Fax Number
Shipping Address (No P.O. Boxes):


Street Address Line 1

Street Address Line 2

City

State

Zip

PARTS REQUIRED
PULSE BOILERS
PART NUMBER
ITEM DESCRIPTION
ITEM PRICE
QUANTITY
62-3333
REPLACEMENT BLOWER A50/100
$350.00 ea
BM-7131
REPLACEMENT BLOWER A100B/AM100
$350.00 ea.
BM-7132
REPLACEMENT BLOWER A150/AM150
$450.00 ea.
BM-7256
REPLACEMENT IGNITION MODULE
$475.00 ea.
BM-8197
5 YEAR TUNE UP KIT 100
$99.00 ea.
BM-8198
Circulator Motor (UP26-64F)
$100.00 ea.
BM-8199
5 YEAR TUNE UP KIT 300
$124.00 ea.


Total Item Price


Indicate state to calculate sales tax
NY     NJ    Other 
Total Order Shipping and Handling
Total Cost of Order