| | HOSE & FITTINGS | HOSE REELS | OIL & GREASE | HARDWARE | DOCUMENTS | ORDER FORM | CONTACT US | |
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HOSE LINE CORPORATION 3700 San Fernando Road Glendale, California 91204 |
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Phone: (818) 547-3010 Fax: (818) 547-3339 Sales@HoseLine.Net |
| CUSTOMER PURCHASE ORDER | |
| DATE: |
P.O. NO./REFERENCE NUMBER: |
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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: |
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PAY BY: [ ] VISA [ ] MASTERCARD [ ] AMERICAN EXPRESS [ ] DINER/NOVUS [ ] BUSINESS/PERSONAL CHECK [ ] MONEY ORDER. |
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ACCOUNT NUMBER & EXPIRATION DATE:
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| NAME & SIGNATURE:
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| SEE HOSELINE.NET WEBSITE FOR TERMS & CONDITIONS. PRINT THIS FORM TO PAPER. LOS ANGELES, CALIFORNIA SALES TAX IS 8.25%, 2003. | |
| PART NO. | DESCRIPTION | QTY. | UNIT PRICE | TOTAL |
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| SUBTOTAL | ||||
| No tax outside California. SALES TAX | ||||
| FREIGHT |
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| GRAND TOTAL | ||||