32022 8th Avenue South, Roy, WA 98580-9640

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CUSTOMER PO#_____________________TODAYS DATE______________________________
PURCHASING AGENT____________________________Email________________________________
CALLER__________________________________Fax#__________________________________
Phone#_____________________________Atten:________________________________________


Invoice To:_________________________ Ship To:______________________________________

Company___________________________Company_____________________________________

Address____________________________Address______________________________________

City_______________________________ City_________________________________________

State_______________Zip____________State_________________________Zip_____________

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Federal Express Account#____________UPS Account#____________Other____________

Item Qty      Catalog #      Size        Description               Price

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Thank you for your order!
Call us at 800-422-8665 or Fax 800-701-2081
If you have have any trouble with your shipment.
Please remit U.S.Funds.
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