Price/Unit Total, Total Order | Dickson Industrial SM720/SM725

Fax to: 1-800-676-0498Mail to: Dickson, 930 S. Westwood Ave, Addison, IL 60101

									Step 1 - Bill To:
Name
Company
Address
City
State														Zip
Phone (			)		–
Email

					Step 2 - Ship To (if different than above)

Name
Company
Address
City
State														Zip
Phone (			)		–
Email

						Step 3 - Ordering Information

Order #				Quantity							Price/Unit								Total
							$									/each			$
							$									/each			$
							$									/each			$
							$									/each			$
															Subtotal:				$
					In Illinois, add 7.5% sales tax									4			Tax:		$
																Freight:			$
					All Prices in U.S. Dollars									4		Total:			$

							Step 4 - Payment Method
	Check: Check #
	Money Order
	Credit Card:
	Credit Card Number:																Expires: (mm/yy)
		–				–						–								/
		–				–						–								/


										Signature
	Purchase Order: P.O.#													(Net 15 days for established customers)
	Customer #:

								U.S.A. Freight Charges
Total Order													UPS 2nd Day					UPS Next			UPSGround
$0-100							$17												$35		$11
$101-400							$21												$44		$16
$401-700							$29												$59		$19
$701-1,000							$38												$62		$27
$1,001-1,500							$57												$79		$40
$1,501-2,000							$75												$99		$47

$2,001-over Please call Dickson Customer Service

All shipments UPS 2nd day unless otherwise requested.

Price/Unit