Fax Order Form Fax# 781-828-8762 Emergency Energy Home
Full Name
Address
Name as it Appears on the card
Full Email ex:anyone@aol.com
Choose one: Visa Mastercard American Express Discover
Credit Card Number. Ex.0000-0000-0000-0000
Expiration Date Ex:dd-mm-yy or mm-yy
Choice of Generators
Generac 5000-6250 Watt Max Surge Generac 4000Watt XL
Generac 5000 Watt SE
Generac 5500 Watt XL Generac 6500 Watt Generac 10,000 Watt EX
Coleman 3800 Watt
Coleman Powerbase 5000-6250 Watt
Coleman 5000 Watt Maxa ER
Coleman Progen 5000
Coleman 7500 Watt Vertex
Generator Accessories
Qty 6 Circuit Transferswitch $249.00
Qty 10 Circuit Transferswitch $349.00
Qty Generac Transfer switch$349.00
Qty 50' 10/4 Twistlock Cord 20amp$179.00
Qty 50' 10/4 Twistlock Cord 30amp$199.00
Qty Bottle of Gas Stabilizer$15.00