Fax / Mail Order Form

P.O. Box 20969                                                          Fax this form to 1-414-546-1797

Greenfield, WI 53220                                                            www. boxesandbags.com

Questions :  888-982-0244                                                      sales@boxesandbags.com
 

Ordered By:

 

P.O.#_____________________________________________

 

Name: ____________________________________________

 

Address:__________________________________________

 

City: ____________________ State:______ Zip:___________

 

Phone:  (DAY) ______________________________________

 

Phone:  (EVE)______________________________________

 

Fax: ____________________________________

 

E-mail:__________________________________

 

Ship to Address

 

Commercial Address. □      Residential Address. □

 

Company:_______________________________

 

Name:__________________________________

 

Address:________________________________

 

City:______________State:______Zip:________

 

Phone: _________________________________

 
You May Photo Copy This Form 
_____of_____


Questions / Comments:

 

 

 Credit Card Payment Information

Name on Card:___________________________________

Billing Address
___________________________________

City, State, Zip____________________________________

We will call you to confirm your order. You can provide us with your Credit Card number at that time.

Please provide a number we can contact you at:_______________________________________

Free

Samples

Stock

Number

Product

Description

Qty

x   Unit Price

=     Total