811 West Main Street ~ Lansdale, PA 19446
Phone and Fax (215) 855-6806
ORDER FORM
Print out this form and use it to fill in the items that you'd like to order
as you look through our site.

 NAME

 DATE

 ADDRESS

 CITY

 STATE

 ZIP

 PHONE

 E-MAIL ADDRESS

QTY

MFG

P/N

DESCRIPTION

PRICE

TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUB TOTAL  

 

PENNA RESIDENTS ADD 6% TAX  

 

SHIPPING  

 

GRAND TOTAL  

 


                     Please circle your choices: It is best to ship heavy items UPS.
          
SHIPPING:        UPS        POSTAL          PVHC  CHOICE

              OK TO BACK ORDER:        YES       NO

              SEND REFUND:         YES         NO

              VISA         MASTERCARD        DISCOVER

              CARD # ___________________________ EXP. DATE _________

    

                    ALL ITEMS SUBJECT TO AVAILABILITY AT TIME OF ORDER

              PRICES SUBJECT TO CHANGE WITHOUT NOTICE


Phone and Fax (215) 855-6806

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