FAX ORDER FORM Back

Please fax this form to 817-759-1004.  Please include your phone number so we can call if we have questions. Bill to: ____________________________________________________________________ Account Number Company Name Your Name ____________________________________________________________________ Complete Address Type of Business (___)________________  _ (___)_________________________________________ Phone Number Fax Number Purchase Order Number Ship to: ____________________________________________________________________ Company Name Attention ____________________________________________________________________ Complete Address City State               Zip ____________________________________________________________________ Delivery Instructions (if required) Prefix/Item Number Color Page Description Quantity/ Unit Unit Cost Extended Cost Need more room? Just attach an additional sheet of paper. Merchandise Total ___________ Sales Tax ___________ TOTAL ___________ Payment Method: [ ]Cash        [ ]Check        [ ]Company Charge# ____________ Card (Name)_____________________________________________ Card # ________________    Exp. ______      Signature ____________________