PROFESSIONAL HARDWARE'S Fax/Mail-In Order Form
Lampstuff.com division / Upholsterystuff.com division

Toll Free Fax - 1-888-836-1919 / Mail To: PO Box 11800 - Casa Grande AZ 85130
Note: MINIMUM ORDER $15.00 This form may be typed on your
computer and will calculate the shipping charges automatically.

Shipping & Handling - Contiguous 48 states Only:

15.00 to 30.00..............7.85
30.01 to 50.00...............9.25
50.01 to 75.00............10.95
75.01 to 100.00...........11.95
100.01 to 125.00.......13.95
125.01 to 150.00........14.95
150.01 to 175.00.......15.95
175.01 to 200.00........18.95
200.01 to 250.00.......21.95
250.01 to 300.00........23.95
300.01 to....................26.95



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