Order Form
New customers please fill in all fields marked with
*
First,Last Name:
*
Company Name and Address:
*
Email address:
*
Phone #:
*
Fax #:
Resale Tax ID #:
*
Payment Method:
(Select)
Credit card on file
Yes
(If
yes
go to order)
Visa
MasterCard
AX
Discovery
Exp. Date :
Card number:
cod
net 30
pre approval require
Note:
This is not secure order form.
If we do not have your credit card on file, please print this form and fax it to us at 1-813-855-6831
or call us at 1-800- 322-3324
There is minimum of $100.00 not including shipping. Orders under $100.00 we have a service charge of $10.00.
To Order:
Please select item #, quantity of each item and size you selected.
1
Item No.
Quantity and size.
2
Item No.
Quantity and size.
3
Item No.
Quantity and size.
4
Item No.
Quantity and size.
5
Item No.
Quantity and size.
6
Item No.
Quantity and size.
7
Item No.
Quantity and size.
8
Item No.
Quantity and size.
9
Item No.
Quantity and size.
10
Item No.
Quantity and size.
11
Item No.
Quantity and size.
12
Item No.
Quantity and size.
13
Item No.
Quantity and size.
14
Item No.
Quantity and size.
15
Item No.
Quantity and size.