(Your Company Name & Logo) Order Form

Please Click Here And Read This Before You Use This Form

My sales letter to my customers for this form.

Download this form in zip format then extract to your desktop to try.

This is a regular e-mail form, but it is still safe from hijacking by junk mailers.

It will send to only one address that can't be changed in this form.

We Can Customize Your Form So Your Customer Number And Ordering Information Will Be Shown As The Default.

Order Type Please select one.
PO Number
Customer #  
Facility Name
Your Name * Required
City State Zip

Phone  Fax  E-Mail *

* Required

Ship To Information (Only If Different Than Information Above)


Ship To Address
City State Zip

We Will Customize Your Form To Provide The Part Numbers and Descriptions of the Items You Buy From Us.

The Price Field Is Optional (We Will Confirm Pricing)

Item # Description Unit Price


123456 The Item(s) You Buy Most $
234567 The Item(s) You Buy Most $
345678 The Item(s) You Buy Most $
456789 The Item(s) You Buy Most $
567890 The Item(s) You Buy Most $
Item # Description Unit Price



Ship Complete Only

Additional Information

Confirm Order Via E-Mail (We Will Correct Wrong Information All The Time)

This is a WORKING demonstration form. Please send only once.

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