ORDER FORM
Promotional Code :___________
Date ________________________ P . O . Number _________________ Customer Number _________________________________________ Phone Number ____________________________________________ Fax Number ______________________________________________ Name of Person Placing Order ______________________________
BILL TO : Name of Business _________________________________________ Street Address ____________________________________________ City ______________________________________________________ State ________________________ Zip Code _____________________
SHIP TO : ( if different than BILL TO information ) Name of Business _________________________________________ Street Address ____________________________________________ City ______________________________________________________ State ________________________ Zip Code _____________________
SHIPPING : Normal Next Day Air ( extra charge ) Other ___________
METHOD OF PAYMENT : ( no COD orders )
Check ( Make check payable to Mayflower Distributing ) Call for credit card information
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ITEM # PRODUCT DESCRIPTION QUANTITY UNIT PRICE TOTAL
May we substitute a like product for any item that is out ? YES NO Are you a new customer ? YES NO
Discounts , if any , will be calculated and applied to your order . Shipping and handling charges , if applicable , will be added to your order . Your order generally will be shipped within 24 hours of receipt order ( not including Saturday , Sunday or holidays ). For ordering additional items , please make copies of this form . Prices subject to change .
tel 800.678.4892 | fax 888.655.0921 | email info @ mayflowerdistributing . com | web www . mayflowerdistributing . com