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We
accept |
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| Order Form Use your browser print button to print as many copies as you need | ||
|
Mail
To:
DRSforms-systems.com 24 Imperial Drive Selden, NY 11784 |
Fax
to:
(631) 696-4901 7/24 |
Office Hours:
Monday - Friday 9:00 AM - 12:30 PM 1:30 PM - 5:30 PM Eastern Standard Time Toll Free: 1 (866) 696-0800 |
| Date
of Order |
|
| Customer
Name |
|
| Ship
to Address* |
|
| Ship
to City, State, Zip |
|
| Telephone
Number |
|
| Fax
Number |
|
| E-Mail
Address |
|
PLEASE
SEND ME: (Fill in only boxes that apply)
|
| Product
No |
Quantity |
Description
|
Color
|
Unit
Price |
TOTAL |
|
*Street
Address only, No PO Box Numbers
|
MERCHANDISE TOTAL
|
|
|
SHIPPING
CHARGE**
|
||
|
TOTAL*
|
| Credit
Card Information **On receipt of order
we will call you with your shipping charges before order is placed. *New York State residents will have tax added to their order. |
| Name
as it appears on Card |
|
| Card
Number |
|
| Expiration
Date |
|
| Street
Address where billed to |
|
| Zip
Code where billed to |
| Customer Signature:_________________________________________________________ | Date: _______________________ |
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