Billing Address |
Shipping Address |
Company Name
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Company Name
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"Bill To" Address:
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"Ship To" Address:
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City:
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City:
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State, Zip:
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State, Zip:
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Attention:
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Attention:
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Phone:
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Phone:
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Fax:
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Fax:
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Purchase Order Number:
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Dept. Code on back of catalog:
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Special Delivery Instructions:
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Page # |
Quantity |
Model No. |
Description/Dimensions |
Price Ea. |
NOA % |
NOA Price |
Total |
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WI residents add sales tax
or supply resellers certificate |
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Merchandise Total |
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Freight Charges |
|
Grand Total |
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Print name on card
|
Signature of person ordering
|
Authorized Signature
|
Date and Phone
|
Prices and manufacturer's product specification subject
to change without notice. Products ordered at different times may not match.
To save freight costs, most items are shipped
requiring some assembly. Prices subject to change without notice.
¹I.M.P.A.C. is a registered servicemark owned
by Rocky Mountain BankCard System and used by Postal Products Unlimited,
Inc. under authorization of Rocky Mountain BankCard System. |