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Model TS4: Multiple Probe Temperature Monitor Alarm

Model 140: Single Probe Temperature Monitor Alarm

CA 5000: Freezer & Refrigerator Alarm Monitor, Liquid CO2 Backup & Injector

Hampshire Controls Corp., Secure Order Form

WELCOME TO OUR SECURE ONLINE PRODUCT ORDERING PAGE

We accept the following credit cards:

*INDICATES REQUIRED INPUT FIELD

1). *Full name:

2). *Company name:

3). *Phone number: (area code and extension):

4). *Fax number: (area code):

5). *Email address:

6). *Zip/Country Code:

7). *List product name, item number, and quantity and price for each:

8). *SHIP TO ADDRESS:

9). Fright collect billing account number (if applicable):

10). Purchase Order number:

11). *BILL TO ADDRESS:

12). *How do you wish your product shipped?

Ground
Second-day
Third-day
Overnight
Cheapest way

13). *Have you used a Hampshire Controls product before?

Yes
No

14). If "yes" to the above question, which product(s) have you used?

15). Please list the application(s) used for our product(s).

16). *How did you find out about Hampshire Controls Corporation?

I'm presently a customer
Co-worker
Professionals' recommendation
Internet search

17). Add any additional comments or questions below:

We Accept the Following Credit Cards: CREDIT CARD VALIDATION INFORMATION
*Full Name (as Shown on Card):
*Credit Card Type:
*Card Number:
*Expiration Date:	Format DD-YYYY
*Safety Code:
*Total Amount: $

Hampshire Controls Corporation
1 Grove Street, PO Box 516, Dover, NH 03821-0516
(Call Toll Free in the US) 866-496-9424 - (Worldwide) 603-749-9424
(Fax) 603-749-9433
(Email) sales@hampshirecontrols.com

Hampshire Controls Corp., Secure Order Form

WELCOME TO OUR SECURE ONLINE PRODUCT ORDERING PAGE

CREDIT CARD VALIDATION INFORMATION