To Order By Fax: Please print and fill out this form, then fax to (727) 531-7849. Alternatively, please fax us whatever order form your company uses to place orders.
To Order By Email: Please print, fill out and scan this form as a PDF document, then email to csl@tampabay.rr.com. Alternatively, please email us whatever order form your company uses to place orders.
| Information |
Billing Address |
Shipping Address |
| Company Name |
_______________ |
_______________ |
| Contact / Attn: |
_______________ |
_______________ |
| Street Address |
_______________ |
_______________ |
| City |
_______________ |
_______________ |
| State or Province |
_______________ |
_______________ |
| Postal Code |
_______________ |
_______________ |
| Country |
_______________ |
_______________ |
| Phone |
_______________ |
_______________ |
| Fax |
_______________ |
_______________ |
| Email |
_______________ |
_______________ |
| Website |
_______________ |
_______________ |
|
| Cat# |
Description |
Qty |
Unit Price |
Total Price |
| ____ |
__________________ |
__ |
________ |
________ |
| ____ |
__________________ |
__ |
________ |
________ |
| ____ |
__________________ |
__ |
________ |
________ |
| ____ |
__________________ |
__ |
________ |
________ |
| ____ |
__________________ |
__ |
________ |
________ |
| ____ |
__________________ |
__ |
________ |
________ |
| ____ |
__________________ |
__ |
________ |
________ |
| ____ |
__________________ |
__ |
________ |
________ |
| ____ |
__________________ |
__ |
________ |
________ |
|
Purchase Order Number:
Credit Card Information (Optional)
Type of Credit Card: Visa or Mastercard (Please Circle One) Credit Card Number:_______________________ Expiration Date:_________ Security Code:______
This information will not be shared or sold. All orders shipped within the USA will be UPS Ground unless otherwise specified. All orders outside of the USA will be shipped via Federal Express. Prices subject to change without notice.
Thank You For Your Order!
|
|
|