PROFESSSIONAL HARDWARE'S Fax/Mail-In Order Form

Lampstuff.com division / Upholsterystuff.com division

Toll Free Fax - 888-836-1919 / Mail To: PO Box 11800 - Casa Grande AZ 85130
Note: MINIMUM ORDER $15.00 - This form may be typed on your computer Shipping & Handling - Contiguous 48 states Only. . . $15.00 to 25.00...7.45 25.01 to 50.00...$8.95 - 50.01 to 75.00...9.95 - 75.01 to 100.00...10.95 - $100.01 to 125.00....12.95 $125.01 to 150.00.... $13.95 - $150.01 to 200.00.... $15.95 - $200.01 & Up.... $17.95

Name:
Company Name (if applicable):

Street Address - Include Suite/Apt #: 
   
City:  State:  Zip/Postal Code: 
Country: USA CANADA
Phone Numbers: Day:  Evening: 
Your e-mail address: 
Payment Option:(Choose one)
Mastercard  Visa  Discover  Amer Express  Money Order/Check in US Funds.
Card Number:
Expiration Date:
Security Code:
(3 or 4 digits)
Cardholder Name EXACTLY as it appears on your Credit Card:  Credit Card billing address if different than above: 

 
Quantity
Product #
Description
Cost
Total
Merchandise Total:
Total Including Shipping:
Press PRINT button. Then fax or mail to: Professional Hardware & Supply Company