FAX ORDER FORM Complete this form and fax to 616-887-3864 Download this form in .doc format Shipping / Contact Information Company:     Name:     Address:     City:     State:   Zip:   Phone:     Fax:     Billing Information Circle Method of Payment: Bill to Existing Charge Account Bill Credit Card (Visa, MasterCard, Discover) *Credit Card Number:     *Expiration Date:     *Card Code: (last three digits on back)   *Billing Address:     *Billing Zip Code:     *for credit card payments only   Order Quantity Description Price                                                 Subotal:     *Total charge will consist of subtotal and UPS shipping costs.  Please indicate if you would like to be notified of total charges before this order is shipped.