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Purchase Order

 

Company Name:_____________________________
Address:___________________________________
City:______________________________________
State:_____________________________________
Zip:_______________________________________
Phone:_____________________________________
Fax:_______________________________________

Contact:____________________________________
Email:______________________________________
P/O#:______________________________________

Date:_______________________________________
Ship By:_____________________________________
Terms:______________________________________
Item:_______________________________________
Description:__________________________________
Qty:________________________________________
Price:_______________________________________
Sub Total:___________________________________
Shipping & Handling:__________________________
Tax:_______________________________________
TOTAL:_____________________________________   

 

 

Payment Details

Please indicate your resale number: Circle only one Purchaser
_________________
 Company Check Casher Check Wire Transfer Credit Card (If credit card, please continue with CC info) Credit Card Name
(VISA, MC, Amex, Discover) Card Holders Name Card Number Exp Date   . . . . . .  

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