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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: 909-468-2035
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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