Print and fax to (909) 591-2350
Order Date ______________
Name ________________________
Title _________________________ |
Purchase Order # _______________ |
ShipTo ___________________
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_______________________
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Bill To ____________________
________________________
________________________
________________________
Phone # ( ) ________________
Fax # ( ) ___________________
Email ________________________ |
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CA
Residents add 7.75% Sales Tax |
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Shipping (see below) |
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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 PCI
Products Company. Freight charges are to be prepaid
and will be added to your invoice. Product weights in catalog are approximate.
