Order Form



                          264 Exchange St. Chicopee MA 01013   -    (413) 598-8119      -      (413) 594-8447 FAX
Qty Stock# Description Unit Price Extended Price

Total Merchandise

Shipping Charges

(If Applicable) Sales Tax

Grand Total

 

Name
Street
Apt #
City
State
Zip Code
Telephone #
   
Credit Card #
Expire Date
Comments
   
Check Enclosed Please say YES if you are paying by check. Shipment will be delayed until check clears the bank.

 

Shipping Charges Fee
Orders up to $25 $5.95
$25.01 to $50 $6.95
$50.01 to $75 $7.95
$75.01 to $100 $8.95
Over $100 Please Call us for Quote

 



 

 

Instructions: Use this form to manually type your order on the computer.
You must add up the charges and type in the totals. If you make an error in your math we will correct it for you. When complete print out this form and either FAX it to us or mail it to us.

The Reset Button will erase ALL info on the form in case you want to start over.