To order, fill out the form, then print it out.  Then fax or mail it to us.  All orders received prior to 2PM (our time) M-F will be shipped out the same day.
  • FAX Number: 1-888-750-6933
  • Mailing Address: Traynor & Associates, Inc.
    10170 McCallum Ave NE, Alliance, Ohio 44601
The PATCH CORD Order Form
How many PATCH CORDs would you like?

How will we ship the PATCH CORDs?

Ohio Residents add 6% sales tax.

TOTAL AMOUNT:

$
Send PATCH CORD(S) To:
Name:

Address:

City:

State:

Zip Code:

Country:

Your Payment Information:
Method Of Payment (DO NOT SEND CASH):

Credit Card Number:

Expiration Date (MMYYYY):

Name (Exactly as it appears on your card):

Please Sign Your Name: --->
(Sign after printing)

 
Contact Information:
Your Office Telephone Number:

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Your Residence Telephone Number:

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Out Of Country Telephone Number:

Your E-Mail Address:

Please add me to your private email list.

(If this box is checked you'll be added to our email list)