Order Form________________________

We will process your order within the next business day. For orders that require special attention, call Par-Metal at (201) 955-0800.

ORDER SPECIFICATION

Please include suffix with each item number (e.g., 10-19082B). Refer to the Price List to calculate your subtotal (excluding shipping).

Stock/Item Number:
 Quantity:
Stock/Item Number:
 Quantity:
Stock/Item Number:
 Quantity:
Stock/Item Number:
 Quantity:
Stock/Item Number:
 Quantity:

CUSTOMER DETAILS

Name:

Company:

Email:

Phone Number:

Shipping Address:

PAYMENT METHOD

Credit Card: Card Number: MMYY: CVV:

- OR -

Net 30 P.O. Number:

- OR -

PayPal Account:

SHIPPING METHOD

Exact shipping costs will be determined when your order is ready.

NOTES

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