PROFESSSIONAL HARDWARE'S Fax/Mail-In Order Form
Toll Free Fax - 888-836-1919 / Mail To: PO Box 11800 - Casa Grande AZ 85230
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

















		   	       Your merchandise total: 
		  	Your total including shipping: 


Press PRINT button. Then fax or mail to: Professional Hardware & Supply Company