Fax page

ORDER FORM
(To use: Print this Form)
Mail or FAX to: Mill Supply Inc., P.O. BOX 28400, Cleveland, Ohio 44128
Call Toll Free 1-800-888-5072 - Fax Toll Free 1-888-781-2700

Ad Code:
WWW
RR

Date:_______________________________________
Purchaser Address: (please print)
___________________________________________ Your Name
___________________________________________ Company Name
___________________________________________ Address (Mail to)
_______________ City	________ State	__________________ Zip
_____________ Daytime Phone		__________________ FAX

E-Mail Address: ______________________________________
Ship to Address: (please print)
___________________________________________________ Your Name
___________________________________________________ Company Name
___________________________________________________ Address (Ship to)
___________________ City	__________ State	___________________ Zip
_________________ Daytime Phone		___________________ FAX

Quantity	Part Number	Side	Short Description	Price	Total







Method of Payment			Sub Total:
[ ] Check or Money Order Enclosed.			Prepaid by check: add 10% U.P.S. shipping; 15% West of Mississippi. When placing your order by Credit Card, COD or O Account, we will apply actual shipping charges. These charges may be higher or lower than the percentages above deding on the size and weight of your package.
[ ] Send C.O.D. (Established Shops Only)
[ ] Use my o account			8% Ohio Sales Tax (Ohio Residents Only) PARTS AND SHIPPING:
[ ] Use my Credit Card			Total:

Please include Credit Card Number, expiration, security code:

Special instructions for shipping: _________________________

___________________________________________________
Thank you for your order, we
appreciate your business.

3 or 4 digit security code

Expiration Date _____/_____

____________________________________________
Customer Signature