FAX Your Order to (815) 874-5713 -----(please print clearly.) ----no P.O. Box addresses

Phone orders at (815)874-4030 ------(GM Code Book handy?)

Print this blank form. Fill it out. FAX us: completed form. Name ______________________________________ Business Name_______________________________ Address_____________________________________ City________________________________________ State________________________________________ Zip Code_____________ Phone: _____ - _____ - ________________ Fax: _____ - _____ - ________________ Charge Card, Circle One Visa or Master Card Card Number________________________________ Expires ________ -_______ - ________ Name on card________________________________

Choose one Code for GM = 48M1 Cuts for this key are = ________________ Code for GM = 39B7 Cuts for this key are = ________________ No Code, No Order You may want to mail this form, with your check or money order, drawn on US dollars to: Sieveking Products Co. 3437 South Bend Rd. Rockford, IL 61109   Call for a quote on shipping charges, if paying by check. You must include the codes, above, for us to ship the order. No Codes? Your order will be returned.

How Many	What Item? See our price sheet.	Price
	Illinois Residents, add 6.25% Sales Tax
	Shipping Charge to your area is determined by weight, your location, and shipper. Total

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