Order Form Word

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					                                               Word      Order Form
Order Information:                                                                Date:
Phone:          (509) 493-3464
Fax: Print this form and fax it to (509) 493-4053
Mail: Send this form to Fiberglass Supply
                          P. O. Box 345
                          Bingen, WA 98605-0345
e-mail: fiberglass@gorge.net Do not include your credit card number if you e-mail this form. We will call
you to confirm order, availability and pricing.
  Item #                           Description                      Price          Qty.         Total




Please note most convenient time and location to reach you, should it be necessary to discuss your order.
                   Billing Address                                         Shipping Address
Name:                                                         Name:
Street:                                                       Street:
City:                                                         City:
State:                                            Zip:        State:                              Zip:
Country:                                                      Country:
Phone:                                  Fax:                  Phone:                       Fax:
e-mail:                                                        e-mail:
Shipping Instructions:




Method Of Payment
COD:                     Master Card:            Visa:       Discover:/Novus      Check:
Name on Card:                                                  Expiration Date:
Card Number:                                                   Signature:

				
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Description: Order Form Word document sample