875 / 884
3.
METHOD OF PAYMENT
❑
VISA
®
❑
MASTERCARD
®
❑
DISCOVER
®
❑
AMERICAN EXPRESS
®
Expiration Date Signature as it appears on card
Name of Cardholder
City State
❑
CHECK
Please make check payable to burton + BURTON
®
❑
CASH
Driver will accept
exact amount of
MONEY
.
❑
CASHIER’S CHECK OR MONEY ORDER
Reorder Form
(Please make additional copies for future use.)
✂
✂
✂
Date P. O. Number
Email Address
Fax #
Customer #
Phone (Daytime) ( )
Phone (Evening) ( )
Name of person placing order
May we substitute with similar product if out of any item?
❑
Yes
❑
No
Discounts, if any, will be calculated and applied to your order. Shipping and handling charges will be added to your order. Your order will
be shipped within 24 hours of receipt of order (not including Saturday, Sunday, or holidays). For additional items, please use another copy of
this page. Prices subject to change without notice. Orders subject to acceptance in Bogart, Georgia. Customer consents to the jurisdiction of
any court in the State of Georgia and the laws of Georgia.
Total number of pages being transmitted including this sheet
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
2.
ORDERED BY
(Only if different from SHIP TO)
Name of Business
Division
Address
City State
ZIP Code™
Country
Product Number
Description
Quantity
Unit Price
Total
4.
ORDER
800-241-2094
Fax 800-880-9759
Local Fax 706-546-8482
Mail to:
burton + BURTON
®
325 Cleveland Road
Bogart, GA 30622
1.
SHIP TO
Name of Business
Street Address
City State
ZIP Code™
Country
Bill To
ZIP Code™
Country