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To Place an order please fill out the following below and email (FomoraSteven@aol.com) or you may fax it to 626-333-6612. PURCHASE ORDER COMPANY NAME:_________________________________________ COMPANY ADDRESS:______________________________________ _______________________________________________________ COMPANY TELEPHONE:____________________________________ COMPANY FAX:___________________________________________ CONTACT NAME: _________________________________________ FORM OF PAYMENT (CREDIT/PREPAID):_______________________ CREDIT CARD #:_________________________________________ EXPIRATION DATE:_____/_____/_____ ITEM #:________________QTY:__________PRICE:___________ ITEM #:________________QTY:__________PRICE:___________ ITEM #:________________QTY:__________PRICE:___________ ITEM #:________________QTY:__________PRICE:___________ ITEM #:________________QTY:__________PRICE:___________ ITEM #:________________QTY:__________PRICE:___________ ITEM #:________________QTY:__________PRICE:___________ ITEM #:________________QTY:__________PRICE:___________ ITEM #:________________QTY:__________PRICE:___________ SUBTOTAL AMOUNT:___________ UPS FREIGHT CHARGES:___________ TOTAL AMOUNT:___________
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