|
Click Here
to Print This Page then Fax this Form for Ordering
24 hour fax and phone
order line: 1- 877 MONKONE (1- 877 666 5663)
You can also mail this form to: 2603
ELECTRIC AVE., SUITE 4, PORT HURON, MI 48060
| *
Required areas in order to process |
Customer
#
PO #
Priority Code:
[ ] New Acct
|
|
*
Billing Information
|
Shipping
Information (if different)
|
| * Name |
|
|
| Company |
|
|
| * Address1 |
|
|
| Address2 |
|
|
| * City |
|
|
* State/Zip
/Country |
|
|
| * Phone/Fax |
|
|
QTY.
|
Product
Code
|
Description |
size/color |
x Unit
Price
|
=
Item Total |
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
| |
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
Sub-Total |
|
|
| Michigan
Customers...
You must add Local Sales Tax of 8% |
|
|
| $4 - USA ..... $6 - CANADA ..... $8 - INTERNATIONAL Shipping |
|
|
| Order Total |
|
|
PRODUCT CODES AND PRICES
|