Boxes and Bags - Customer Fax Order Form

Fax / Mail Order Form

P.O. Box 20969 Fax this form to 1-414-546-1797

Greenfield, WI 53220 www. boxesandbags.com

Questions : 888-982-0244 sales@boxesandbags.com

Ordered By:

P.O.#_____________________________________________

Name: ____________________________________________

Address:__________________________________________

City: ____________________ State:______ Zip:___________

Phone: (DAY) ______________________________________

Phone: (EVE)______________________________________

Fax: ____________________________________

E-mail:__________________________________

Ship to Address

Commercial Address. □ Residential Address. □

Company:_______________________________

Name:__________________________________

Address:________________________________

City:______________State:______Zip:________

Phone: _________________________________

You May Photo Copy This Form _____of_____

Questions / Comments:

Credit Card Payment Information

Name on Card:___________________________________

Billing Address___________________________________

City, State, Zip____________________________________

We will call you to confirm your order. You can provide us with your Credit Card number at that time.

Please provide a number we can contact you at:_______________________________________

*Free* *Samples*	*Stock* *Number*	*Product* *Description*	*Qty*	*x Unit Price*	*= Total*