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Mail to:
Fax (205) 678-0841 |
| Check/M.O. Number: | Amount: | |
| Phone (if we have a question about the order): | ||
| Billing Address: | ||
| Name: | ||
| Address: | ||
| City: | State: | Zip: |
| Ship to Address: (If different from above address) | ||
| Name: | ||
| Address: | ||
| City: | State: | Zip: |
| Qty. | Item # | Description | Unit Cost | Total |
|---|---|---|---|---|
| Item Total: | ||||
| Please add 8% of item total to orders shipping to AL: | ||||
| Shipping & Handling: (See chart) | ||||
| Subtotal: | ||||
| TOTAL | ||||