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Schools & Government Order Forms
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We accept purchase orders from
any Public Schools & Universities or Federal & Local Government Offices. Please print
out this page and fill the form out as completely as possible then fax it
back to us to process your order.
Fax Number: 909-248-2425
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Shipping Info: |
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Name of Contact:_____________________________________ |
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Name of Agency: _____________________________________ |
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Division/Department:__________________________________ |
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Phone Number: ( )______-___________ |
Email Address:___________________ |
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Shipping Address |
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State |
Zip Code |
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_________________________________________________________
____ _____________ |
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Payment Info: |
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Type of Credit Card: |
Expiration Date: |
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Month Year |
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Visa |
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______ |
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Master Card |
____ |
______ |
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Discover |
____ |
______ |
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Express |
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______ |
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Billing Address |
State |
Zip Code |
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_________________________________________________________
____ _____________ |
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Items You Want to Order: |
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Product Name |
Code |
Price |
Qty. |
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______________ _______________
_____________ |
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________________________________
______________ _______________
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________________________________
______________ _______________
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________________________________
______________ _______________
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Special Instructions: |
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_______________________________________________________________________________________________ |
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_______________________________________________________________________________________________ |
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