Purchase Order
Date:
BILL TO:
[Name
[Company Name]
[Street Address]
[City, ST, Zip Code]
[Phone]
[Fax]
[Email]
SHIP TO:
Same as Bill To
[Name]
[Company Name]
[Street Address]
[City, ST, Zip Code]
[Phone]
[Fax]
P.O Number
Shipping Method
Delivery Date:
Payment Terms
Due Date:
Quantity:
Item #
Description
Unit Price
Ship Via :
Customer Account Number:
Ship Method:
Credit Card Number:
Expiration Date:
Cvv Code:
We Accept Major Credit Cards
Credit Card Billing Address:
Notes / Instructions
Please note If for any reason Customer cancel an order after is cut or before
shipped a cancellation fee of 10 % of the order amount will be charged.