Order Form

"Please Check To Select" - [ New ] Or [ Existing ] Customer

Select Warehouse To Ship From: Select Shipping Location - Pick List   North East - Somerset, New Jersey Southeast - Duluth, Georgia Midwest - Elgin, Illinois South - Elgin, Illinois Note: Houston, TX - closed / Pick Elgin Western - Redlands (LA), CA   Ship From Closest Location   - Optional

Select Shipping Method: UPS Ground - Default Method   On UPS Account # - Entered in Comments By UPS - Next Day Air By UPS - 2nd Day Air On FedEx Account # - Entered in Comments By U.S. Postal Service - Priority Mail Cheapest Way By Truck   See Note In Comments Section Below   - Optional

Payment Method: Please Select A Payment Method - Required - Pick List   I Will "Mail A Check" - after Receiving Order and Mailed Invoice ************************ Visa Card - Payment after Receiving Order and Mailed Invoice ************ MasterCard - Payment after Receiving Order and Mailed Invoice ************** American Express - Payment after Receiving Order and Mailed Invoice ********************** Discover Card - Payment after Receiving Order and Mailed Invoice ***************** Diners Club Card - Payment after Receiving Order and Mailed Invoice ********************* ACH Bank Payment - Electronic Funds Transfer - (Setup Required) ************************ My "PayPal" Account - Payment after Receiving Order and Mailed Invoice **************************   Notes:   --- Typed Invoices Are Always Mailed After Delivery Of Products   --- We Accept POs by Fax, Mail, E-mail or this Order Form   --- For A Signed W-9 Go To The Link Directly Below This Order Form   --- Actual Shipping Charges Are Added To Invoices (No Handling)     * Credit Card Payment Instructions Are Included With Your Invoice *   ************************************************************************************   - Required

First Item Being Ordered:

Re-Orders: - "Same Product(s) and Quantity" - [ Yes ]

1st Item Catalog or Item Number:   Catalog or Item Number

Quantity of Box(es) or Carton(s):  - Required

Please specify for Purchase Orders

** Second Item Being Ordered:

Re-Orders: - "Same Product(s) and Quantity" - [ Yes ]

2nd Item Catalog or Item Number:   Catalog or Item Number

Quantity of Box(es) or Carton(s):  - Required

Please specify for Purchase Orders

** Note: When ordering more than Two (2) items simply insert commas between Catalog Numbers and Quantity of Boxes.

Order Information:

Your Name: - Required !!!        

E-Mail ( Required ): - Please Check Spelling.

Organization: - Optional

P.O. Number: - Optional      

Shipping Address:

Re-Orders: - "Exact Same Address as Prior Order" - [ Yes ]

Ship To The Attn:                     
Address 1 :         
Address 2 :     
City:
          State: - Required                                                    
            Zip Code: - - Required                                       
      Country:                                        

Phone and Fax Numbers:

   Phone Number: - -  - Required For Orders !!!    

    Fax Number: - -  - Required If Available

Please specify for Purchase Orders