Printable Order Form
Current prices, policies and order form effective from January 1 1999 to Dec 31 1999
Print, then Mail or Fax this Order Form To:
Hoosier Tool Company P.O. Box 492 Mentone In 46539
FAX 1-219-353-1130
*BILLING INFORMATION* *SHIPPING INFORMATION*
(As it appears on credit card or check) (If different from Billing Information)
Name:_____________________________________ Name:____________________________________________
Address:__________________________________ Address:_________________________________________
City:_____________________________________ City:____________________________________________
State/Province:___________________________ State/Province:__________________________________
Zip/Postal Code:__________________________ Zip/Postal Code:_________________________________
Daytime Telephone Number:_________________ Fax Number:________________________
*PAYMENT INFORMATION*
Payment Method - Check One:
( ) VISA ( ) MasterCard
Credit Card Number:_______________________________ Credit Card Exp. Date:_______________
Signature:_________________________________________________
( )Check Or Money Order Payable to "Hoosier Tool Company"
PRODUCT INFORMATION:
QTY ITEM PRICE TOTAL
______ ___________________________________ _________ $______________
______ ___________________________________ _________ $______________
______ ___________________________________ _________ $______________
______ ___________________________________ _________ $______________
Subtotal $______________
5% Indiana Sales Tax (Indiana Residents Only) $______________
Regular U.S. Shipping ($6.00 Per Tool - $18.00 Maximum) $______________
Canadian Shipping (Air Parcel Post): ($12.00 Per Tool - $18.00 Maximum) $______________
Total $______________
© Copyright Hoosier Tool Company All Rights Reserved.