Docstoc

Purchase Company

Document Sample
Purchase Company Powered By Docstoc
					1) Please fill in all the contact information and credit card information if you are paying with plastic.
2) Please indicate the quantities required and fax this form to (732) 389-9044

       [Company Name]                                                      Purchase Order #                 Date:

                                                                                                            7/9/2010


       Bill To:                                                              Ship To:
       [Name]                                                                [Name]
       [Company Name]                                                        [Company Name]
       [Street Address]                                                      [Street Address]
       [Address 2]                                                           [Address 2]
       [City, ST ZIP Code]                                                   [City, ST ZIP Code]
       [Phone number]                                                        [Phone number]
                        email
     Visa/MasterCard Number
                     Exp Date
                          CID
         Name on Credit Card
            Phone on CC Record


       Qty          Item #                       Description                 Unit Price            Total
              TSK1954              Bariatric Bedpan                              $150.00
                                                                       -
              TSK2190              Bariatric Briefs (32/case)                    $135.00
                                                                       -
              TSK1099              Bariatric Socks (24 pair/case)                  $95.00
                                                                       -
              TSK31                Bariatric Blood Pressure Cuffs                  $70.00
                                                                       -
              TSK26                Bariatric Shower Commode Chair               $1,795.00
                                                                       -
              TSK36                Bariatric Commode                             $795.00
                                                                       -
              TSK750               Bariatric Walker                              $525.00
                                                                       -
              TSK850ADV            Bariatric Wheelchair (30")                   $2,050.00


                                                                                 Subtotal
                                                      Special Handling (Outside Lower 48)
    If you have any questions, please contact:                                   Subtotal
    Michael Klein                                                           Sales tax rate
    (732) 982-1090                                                  Sales tax on purchase
    maklein@tskproducts.com                                     Merchant Services (CC) Fee
                                                                                    Total


                                   Thank you for your business!

				
DOCUMENT INFO
Description: Purchase Company document sample