PHONE, MAIL or FAX
Order Form
Terms and Conditions: |
ORDERED BY: Purchaser: _________________________________________ Company (if trade): __________________________________ Street Address: _____________________________________ __________________________________________________ City: _______________________ State:_____ Zip:________ Signature: _________________________________________ Phone Number:( ) ___________________________ We will call you only if we have a question about your order. Credit Card Number: ________________________________ Expiration Date: ________________ MC _____ Visa _____ |
Print out this order form to order by mail or fax it to 301-774-6249.
To place your order by phone, call toll-free 800-451-6411.
| ENTER YOUR ORDER HERE USE EXTRA SPACE TO BE AS DETAILED AS POSSIBLE |
||||
| QUAN. |
CODE |
TITLE |
PRICE |
EXT. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| SUBTOTAL |
|
| MD Addresses please add 6% Sales Tax or Tax Resale Certificate I.D. Number: |
|
| Packaging, Shipping & Ins.: $14 |
|
| Office Use: New / Catalog / PAID with Check # TOTAL |
REV: January 1, 2009 ©HAILS 2009