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Schools & Government Order Forms



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Schools & Government Order Forms

We accept purchase orders from any Public Schools & Universities or Federal & Local Government Offices. Please print out this page and fill the form out as completely as possible then fax it back to us to process your order.

Fax Number: (909) 248-2726
Shipping Info:
Name of Contact:_____________________________________
Name of Agency: _____________________________________
Division/Department:__________________________________
Phone Number:  (         )______-___________ Email Address:___________________
Shipping Address State Zip Code
_________________________________________________________ ____                     _____________
Payment Info:
Type of Credit Card: Expiration Date:
Month                        Year
Visa ____ ______
Master Card ____ ______
Discover ____ ______
Express ____ ______
Billing Address State Zip Code
_________________________________________________________ ____                     _____________
Items You Want to Order:
Product Name Code Price Qty.
________________________________ ______________ _______________ _____________
________________________________ ______________ _______________ _____________
________________________________ ______________ _______________ _____________
________________________________ ______________ _______________ _____________
________________________________ ______________ _______________ _____________
Special Instructions:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________





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