| Items
(please include specific item #'s when available):
|
| |
| |
| |
| |
| |
*Please
attach additional pages if necessary. Also include any available
facility diagrams or specs. |
| Billing
Info: |
| Name: |
|
Organization: |
|
| Address: |
|
City/State/Zip: |
|
| Phone: |
|
| Email: |
|
Fax: |
|
| Internal
PO #: |
|
Payment
Method: |
|
| Credit
Card Info (if applicable - should match with
info above): |
| Credit
Card Type: |
|
Card
Number: |
|
| Expiration
Date: |
|
PIN
(3 or 4 digits): |
|
| Shipping
Info (circle 'SAME AS ABOVE' if applicable): |
| Name: |
|
Organization: |
|
| Address: |
|
City/State/Zip: |
|
| Phone: |
|
| Email: |
|
Fax: |
|
| Notes/Requests: |
|
*Payment
Terms: Purchase Orders accepted from Schools, Government
Agencies, & Municipalities -- please also attach Certified
PO to this form
*Full
pre-payment required from all other customers in the form
of Credit Card, Money Order, Cashiers or Personal Check |
| Date: |
|
Your
Name/Title: |
|
Signature: |
|
|
|
|
| If
mailing, please send to: |
| Practice
Sports, Inc. |
| P.O.
Box 1463 |
| Bellevue,
NE 68005-1463 |
|