Sample Request

 

Purchase Order #

Samples are offered at end quantity pricing.

Name of Company
Address
 
 
Telephone Fax
E-mail Work Order #
Purchase Order Date Date Required
PST Registration # Federal ID#
BILL TO :
SHIP TO :
Order placed by: Ship via: Terms:
Item number Item detail Color S M L XL XXL Other Unit Price $ Total Price $
  Sub Total
Freight
GST
PST
Total
Advance Paid
Amount Due
Remarks:

 

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