Drawer Slides Order Form

Print out and complete the form below. Please mail with a check payable to QM Replacements (the factory is not set up to accept credit cards) and mail to:

QM REPLACEMENTS
96 COMMERCE DR #181
READING, PA 19610

Name
Address
City
State Zip
Phone

Type of Drawer Slide
Price per Set
# of Sets
Total
Replacing Drawer Slide #1
$19.00
Replacing Drawer Slide #2
$19.00
 
Thank You
Subtotal
 
Shipping & Handling
included
Grand Total