Del City Interactive Catalog Page 405

405 f:1.800.431.1293 1.800.654.4757 N85 W12545 Westbrook Crossing, Menomonee Falls, WI 53051 fax order form FAX ORDER FORM please fax to 1.800.431.1293 or ship to: company contact shipping address city state zip phone fax email address bill to: (if different than ship to) company contact billing address city state zip phone fax email address payment method: C.O.D. open account customer no. credit card expiration card number card holders signature mo. yr. shipping information: carrier preference If an item is currently not available, how would you like backorders to be handled. ship backorder when product becomes available cancel backorder please call if there are backorders comments customer purchase order number: Del City part no. description quantity price amount total = (If ordering more than 10 line items, please fax additional pages with this form.) Freight and appropriate tax charges are incremental and will be added to your order.

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