Order Form
Date:
Consignee Phone Number ____________________
Emergency Contact Number_____________________
Consignee Email_______________________________
Ship to: Consigneer_____________________________________
Address_______________________
City_______________State:__________ Zip code:__________
Commercial Address (Write yes or no in the box below)

 

Residential Address (Write yes or no in the box below)

 


Do you have a forklift? (Write yes or no in the box below)

 


Do you need a lift gate? (Write yes or no in the box below)

 


What are your open hours? _______________

Do you need an appointment? _________________

 

 

Category

Item Number

Quantity

Price

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                  



Payment Information

Direct Deposit    Online Transfer     Zelle      Check               Visa/Master Card ( 3.5% processing fee)