Integrations

Order By Fax

Print this form and fax to:
800-845-1535

Ship To

Facility
Name
Title
Department
Address
City
State Zip
Telephone
Fax
Email
Current Customer
New Account

Bill To

Facility
Name
Department
Address
City
State Zip
Telephone
Fax
Email

Payment Method

Must be a school, government agency or current account holder to pay via P.O.
Purchase Order Number
Account Number (for Current Customers)

To process a credit card order, you must enter the credit card holder's "Bill To" address
Visa    MasterCard
Number    Exp.
Cardholder Name
Address
City
State    Zip

Shipping Method

Next Day Delivery (additonal cost: please call 800-283-5700)
2 Day Delivery (additonal cost: please call 800-283-5700)
Regular Delivery

Shipping Charges for Regular Delivery

Continental U.S.
- Minimum Shipping Charge is 7.50 U.S. Currency
- Add 15% of merchandise subtotal
Alaska and Hawaii
- Minimum Shipping Charge is 20.00 U.S. Currency
- Add 20% of merchandise subtotal

Which Items Would You Like to Order?

OTY. ITEM # COLOR SIZE DESCRIPTION UNIT $ TOTAL $

Merchandise Subtotal
Sales Tax (CA, FL, GA, IN, MA, MI, NC, NY, OH, SD, TN, TX, and WI residents) or exeption number
Shipping and Handling
Total Order

Signature

Print this form and fax to:
800-845-1535