Order Form
Print and fax to (909) 591-2350
Order
Date______________
Name________________________
Title_________________________ |
Purchase
Order #_______________ |
ShipTo___________________
_______________________
_______________________
_______________________
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Bill
To____________________
________________________
________________________
________________________
Phone # (
)________________
Fax # ( )___________________
Email________________________ |
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Name/Description |
Quantity |
Unit Price |
Total |
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Sub-Total |
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CA
Residence add 7.75% Sales Tax |
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Shipping
(see below) |
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Total |
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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.
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Providing
Excellent Products and Customer Service Since 1985
