PHONE OR FAX YOUR ORDER

Please print out page, Fill Out information and Phone or Fax to (845) 614-7323 . (we will fax or email your payment recipt)

PLEASE PRINT OUT

COMPANY NAME:__________________________

NAME: _______________________________

ADDRESS:_________________________________

CITY_______________STATE:____ZIP_____

TEL:___________________FAX:__________

EMAIL ADDRESS:_______________________

ORDER/QUOTE (PLEASE CIRCLE)

(quote will include shipping costs)

_____________________________________

_____________________________________

_____________________________________

_____________________________________

attach extra page if needed.

SHIPPING INFO: __ Check here if same as above)

NAME_________________________________

ADDRESS______________________________

CITY____________STATE:_______ZIP______

BILLING INFO:

MASTER ____VISA_____AMERICAN EXPRESS____

NAME ON CARD:___________________________

ADDRESS ON CARD__________________________

CITY______________ST.__________ZIP______

EXPIRATION DATE:__________CV #__________