TERMINALS PLUS

Order Form
Fax 602-504-8500
Company:___________________________________________________ Date ___________
Address: _____________________________________________________ PO # _________
City:_____________________________ State: __________________ Zip: ______________
Authorized Buyer___________________________________ Telephone:________________
Signature ________________________________________Resale #____________________
Payment Enclosed_____________ VISA CARD #__________________________________
Mastercard #____________________________ Sec Code ______ Card Exp Date ________
Name on Card _______________________________________________________________
Billing Address for Card _______________________________________________________
_________________________________________________________
This Order Qualifies For Free Shipping? $175.00 minimum (excluding spark plugs, chemicals) Yes _______ No _________

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Subtotal $______________

I Authorize TERMINALS PLUS, to charge my credit card for this amount $ _________
Signed ____________________________________________ Date ________________
Printed Name ______________________________________ DL#_________________

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