Mr. G's Enterprises - Order Form

5613 Elliott Reeder Rd. - Ft. Worth, Texas 76117-6013

Billing Address

Shipping Address

 To:

 To:

 

 

 

 

 Phone #:

 (Must select one)    Is Shipping address:

               Home □           Business □

 Fax #:

 Email:

Note: Please give a street address. Truck lines and UPS will not deliver to a P.O. Box.

Your Order #

Date Shipped

Shipped Via

F.O.B. Point

Terms

 

 

 

 

 

Part Number

Qty

Shipped

B/O

Description

Unit Price

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Credit Card Information

 Sub Total (Min $10.00)

 

 

 

 Card #  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Exp Date

 

 

/

 

 

 Sec Code

 

 

 

 

 Shipping (depends on weight   and size - min $10.00)

 

 

 Texas 8.25% Sales Tax

 

 

 Billing Address:

 C.O.D. $12.50

 

 

 

 Total Amount

 

 

 Check One:     □ Visa   □ M/C   □ A/E   □ Disc.

September 2012
Prices subject to change without notice.

 Customer Signature:

Phone: (817) 831-3501 -- (817) 838-3131
Fax: (817) 831-0638
E-Mail: [email protected]