Order Form
DATE: ________________ Print and Fax order to 209-267-5984
NAME: _______________________________________________________________________
COMPANY:____________________________________________________________________
PHONE #: _______________________________ FAX#:________________________________
ADDRESS: _______________________________________ E-MAIL:_____________________
CITY: ______________________________________ STATE: _______ ZIP: ________________
| QUANTITY | ITEM / UNIT DESCRIPTION | PRICE |
SUBTOTAL |
||
Shipping and handling will be added to all orders .......TOTAL DUE |
Minimum Order: $25.00 PAYMENT METHOD: COD ( )+ $8.00 Credit Card ( )
VISA/MASTER CARD
Circle the type of card
you are using.
Credit Card # _____________________________Exp Date:________ 3-Digit Code _________
Billing Zip_______
Full Name Listed on Card: ___________________________________________________________
Authorized Signature: ______________________________________________________________