Page 70 - KNA Supply Pro-Shop Catalog 2024
P. 70
KNA ORDER FORM
___CALL FOR PAYMENT
(352) 351-1170 - PHONE
(352) 351-2600 - FAX ___SEND PAYPAL INVOICE
[email protected]
www.knasupply.com ___CHARGE TO CARD ON FILE
___NET 30 DAYS
ACCT #__________________________________DATE_______________________ (With approved credit application)
SHOP______________________________________________________________
ADDRESS_________________________________________________________________________________
CITY____________________________________STATE_____________________________ZIP____________
CONTACT_________________________________________________________________________________
PHONE NUMBER__________________________________________________________________________
EMAIL ADDRESS___________________________________________________________________________
Cust. PO# Credit Card Info: # Of Pages
(3) NAME:
PART NO. QUANTITY DESCRIPTION PRICE EXTENSION
1
Account#: Contact:
2
Address:
3
City: State: Zip Code:
4
Tel.# Fax#
5
(4) NAME:
6
DBA:
7
Account#: Contact:
8
Address:
9
10
11
(5) NAME:
12
DBA:
13
Account#: Contact:
14
Address:
15
16
17
18
19
20
SUBTOTAL:
Signature FREIGHT:
TAX:
TOTAL:
