Order Form
Download Excel Document of
Order Form
   
Date: __________________________________ Sales Person: __________________________________
   
Account #:   P. O.# :  
Acct.Class:   Terms:  
Credit Card:   Cardholder Name:  
Credit Card #:   Exp. Date:  
Signature:  
   
Ship To   Bill To  
Name:   Name:  
Company:   Company:  
Address:   Address:  
       
Phone:   Phone:  
Fax:   Fax:  
Email:   Email:  
   
NOTE: Must have Resale Certificate for Sales Tax Exemption submitted or on file.
   
Federal ID: ______________________________ New Address:     YES _____   NO _____
State ID:     ______________________________  
   
Item Number
Description
Quantity
Unit Price
Subtotal
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
 
Freight: ____________
 
Total: ____________
Special Instructions: __________________________________________________________________________
Back Order Allowed:     YES _____  NO _____ Freight Terms:     Prepaid _____  Collect _____