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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
RUST

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 Open Account, we will apply actual shipping charges. These charges may be higher or lower than the percentages above depending on the size and weight of your package. Minimum $7.75
[ ] Send C.O.D. (Established Shops Only)
[ ] Use my open 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