PHONE: 508-752-5095 FAX 508-752-6004
Use this handy order form to fax your order in or to make notes of items you are interested in.
Bill-to: Ship-to:
Company:_________________________________________________ Company:_________________________________________________
Attention:__________________________________________________ Attention:__________________________________________________
Address:__________________________________________________ Address:__________________________________________________
City:____________________________State:______ Zip:____________ City:_____________________________State:_______ Zip:__________
ORDER DATE:______________ P.O._____________ DATE NEEDED:________________
Line Quantity Item No. Description Unit Price Amount
Subtotal_____________________
Less Discount____________________
Net Product______________________
Mass. Sales Tax 5% _____________________
Shipping/Freight______________________
TOTAL DUE ______________________
Payment Method: __Check to be mailed __Credit requested, please send application __Dealer Account
__50% with order/ 50% upon shipment __Established account
Credit Card Payment Authorization- check one: __
__
__ 
PRINT Name as on card ____________________________ Signature __________________________
Complete address as on credit card statement Amount to be charged $____________
_______________________________________________ Account #____________________________
_______________________________________________ Expiration Date________________________
ORDER AUTHORIZATION All orders must be signed below by company officer.
Printed name of person signing this order _______________________________________
Signature________________________________
