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HOSE LINE CORPORATION
3700 San Fernando Road
Glendale, California  91204 		Hose Line Corporation Phone:  (818) 547-3010
Fax:  (818) 547-3339
Sales@HoseLine.Net

CUSTOMER PURCHASE ORDER
DATE:

 P.O. NO./REFERENCE NUMBER:
BILLING ADDRESS
COMPANY NAME:
NAME:
PHONE:
FAX:
ADDRESS:
CITY:
STATE + ZIP CODE:
COUNTRY:		 SHIPPING ADDRESS
COMPANY NAME:
NAME:
PHONE:
FAX:
ADDRESS:
CITY:
STATE + ZIP CODE:
COUNTRY:
SHIP VIA: [  ] WILL CALL. [  ] UPS [  ] OTHER. DATE EXPECTED:
PAY BY: [  ] VISA [  ] MASTERCARD [  ] AMERICAN EXPRESS [  ] DINER/NOVUS [  ] BUSINESS/PERSONAL CHECK [  ] MONEY ORDER.
AMEXACCOUNT NUMBER & EXPIRATION DATE:
NAME & SIGNATURE:
SEE HOSELINE.NET WEBSITE FOR TERMS & CONDITIONS. PRINT THIS FORM TO PAPER. LOS ANGELES, CALIFORNIA SALES TAX IS 8.25%, 2003.
PART NO. DESCRIPTIONQTY. UNIT PRICETOTAL
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
  
 
 
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
SUBTOTAL  
No tax outside California. SALES TAX  
FREIGHT
 
GRAND TOTAL