DATE
ORDERED
|
DATE
REQUIRED
|
F.O.B.
MILLDALE, CT |
| QUANTITY
ORDERED |
TOOL
NUMBER |
DESCRIPTION |
MATERIAL
COATING |
UNIT
PRICE |
AMOUNT |
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Subtotal Before Shipping: |
| Preferred shipping is UPS ground. |
|
Total with Shipping & Handling: |
|
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| (Please circle method of
payment) |
| _____________________ |
____________ |
__________________________________ |
| CARD NUMBER |
EXPIRATION |
SIGNATURE |
| |
|
| If mailing, you may enclose a check
or money order (drawn on a U.S. bank). |
| |
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| ORDER NUMBER
__________________________ |
CUSTOMER NUMBER
_______________________ |
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