CUSTOMER ORDER FORM     Print & Fax to: 416-869-0616

CUSTOMER INFORMATION
Name Date
Company  Order No.
Address 1 FOB
Address 2 Sales Rep
City State Zip Office Use
Phone Fax

SHIPPING  INFORMATION IF DIFFERENT FROM ABOVE
Name Phone No.

Currency (check one)
Company
$US       ............
Address 
$Cdn     ............
City State/Prov. Zip

ORDER INFORMATION
Item Quantity Part No. Description Unit Price Total Price
           
           
           
           
           
           
           
           
           

PAYMENT INFORMATION

 Sub-total    
Credit Card Visa  .........  MasterCard........ Amex  .........   Discover   ........ Shipping     
Card Number Expires .............. 8% PST: ON orders only    
Cardholder Verification Number * Visa/MC/Discover............... Amex ........................... 7% GST: Cdn orders  only    
Name on Card Cardholder Address TOTAL    
City Prov/State
Phone No. E-mail Address

*For VISA, MC and Discover, it is a three digit number appearing on the back, in or immediately above the signature panel.  For AMEX, it is a four digit number appearing on the front of the card, above the embossed card number.

Industry Depot is a division of Inventory Depot, Inc.  Phone Toll Free 888-849-8034