Please Fill Out All Areas of This Form. (You Can Print This Form To Use As A Receipt Or To FAX)
*NOTE: THERE WILL BE A $5.00 SERVICE FEE FOR ORDERS UNDER $50.00

 
STEP ONE
Customer Information
Required*
Name or Company:*

Customer Number:
Address:
City/State/Zip:

Country:
E-mail:
Payment Terms (click your option)*
Shipping (click your option)* Ship to:
Ship To Address:

Phone:
Fax:
Credit card

Credit Card Number:
Expire Date:
Card Holder:

Credit Card CID Number
 Today's Date:
STEP TW0
Order
Information
Below type in the stock number followed by quantity by the dozen. All transfers are sold by the dozen.

 

Please double check your stock numbers and quantity.
 
STEP THREE
Customer Service Will Call To Confirm Your Order!