Order Form | AbsorbentsOnline
Print and fax to (909) 591-2350 Order Date ______________ Name ________________________ Title _________________________ Purchase Order # _______________ ...
- Family-Owned Since 1985
- Ships from National Warehouse Network
- Expert Support: (800) 869-9633
Order Form
Print and fax to (909) 591-2350
|
Order Date ______________ Name ________________________ Title _________________________ | Purchase Order # _______________ |
|
ShipTo ___________________ _______________________ _______________________ _______________________ |
Bill To ____________________ ________________________ ________________________ ________________________ Phone # ( ) ________________ Fax # ( ) ___________________ Email ________________________ |
| Item # | Name/Description | Quantity | Unit Price | Total |
|---|---|---|---|---|
| Sub-Total | ||||
| CA Residents add 7.75% Sales Tax | ||||
| Shipping (see below) | ||||
| Total |
Method of Payment (Check one) ( )VISA® ( )MasterCard® ( )American Express® ( )Discover®
Card #___________________________Exp. Date________
Card Holders Name_________________________________
Card Holders Signature______________________________
Comments:
*Orders are shipped FOB from our nearest location at the discretion of PCIProducts Company. Freight charges are to be prepaid
and will be added to your invoice. Product weights in catalog are approximate.
