AFCO Equipment & Engineering | 800.345.1329
Page
73
ORDER FORM
SOLD TO
SHIP TO
… If different than “Sold To”
Customer Number
Company Name
P.O. Number
Contact / Title
Company Name
Street Address
Buyer’s Name
City / State / Zip
Street Address
City / State / Zip
ORDERS
Phone
PHONE
800.345.1329
Fax
FAX
717.265.9182
Valid e-Mail
WEBSITE
ORDER INFORMATION
QTY
PART NUMBER
CATALOG PAGE NUMBER & DESCRIPTION
UNIT
TOTALS
Dollars
Cents
WE WILL SHIP PRE-PAID AND INVOICE YOU FOR THE CHARGES
HOURS:
MONDAY through FRIDAY | 8:00 AM to 4:00 PM ET
Place your order 24 / 7 at
SUBTOTAL
TAX*
TOTAL
* Add 8% Sales Tax for: PA
METHOD OF PAYMENT
AFCO Account / PO -
Check Enclosed -
VISA -
MASTERCARD -
AMEX -
DISCOVER -
CARD NUMBER:
EXP DATE:
CVC CODE:
SIGNATURE:
MAKE CHECKS PAYABLE TO:
Alex C. Fergusson LLC | AFCO
