If you wish to order by credit card but prefer to place your order by FAX rather than online, and you are located in the continental United States, please print this page, fill out the order form and fax it to 1-866-883-2282.
Please do not fax Purchase Orders of any kind. Payment is by Credit Card ONLY. Email Address (example: JohnDoe@aol.com):_____________________________________
Shipping Address (No Post Office boxes please.)
Name: _______________________________________________________________
Company Name:________________________________________________________
Street Address: _____________________________________________________
City:_______________________________ State:_________________
Zip Code:______________________ Phone:______________________
Item Code & Description Price Quantity
Example:
#53-8400 5 Inch 8 Hole 400 Grit Hook & Loop Discs 50-Pack 11.95 1
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Card Number: ________________________________ Expiration Date: _____/________
Last 3 digits on Signature Panel on back of card: _______
VISA/MasterCard/Discover Only. If AmEx, 4 digit code from front of card.
Cardholder Name:____________________________________________________________
Credit Card Billing Address:________________________________________________
City:_____________________________________ State:___________
Zip Code:______________________ Phone:__________________
Signature:___________________________________________ Date:____/____/______