Wholesale Order Form  Print & Fax/Mail

Billing Information

Name ________________________Order #          

Address ______________________ Email _____________@________

City _______________________ State ___ Zip _______

Phone ___-_____-_____  Fax ___-____-______

Card or Check # _________________________


Shipping Information :

Name    _______________________________

Address 1  _________________________

Address 2 ___________________________

City ______________ State ________ Zip ______

Phone ____-____-_____  Fax ___-____-_______


Products Ordered :

Item Number ____________  Description __________________  Price ______  Your Price _________

Item Number ____________  Description __________________  Price ______  Your Price _________

Item Number ____________  Description __________________  Price ______  Your Price _________

Item Number ____________  Description __________________  Price ______  Your Price _________

Item Number ____________  Description __________________  Price ______  Your Price _________

Item Number ____________  Description __________________  Price ______  Your Price _________

Item Number ____________  Description __________________  Price ______  Your Price _________

Total ____________________

Discount___________________

Total  __________________

Shipping ___________________

Grand Total _________________

Accept Back Order____________

Use additional  if needed. 

Fax to 865-674-2870.

Office Use Only ________ Customer ____Date ____ Filled _____#