Wisconsin Industrial Products: Printable Order Form

Fax Order Form

Wisconsin Industrial Products

Fax to 262-723-1335

P.O. Number:	___________________________________
Date:	___________________________________
Name:	___________________________________

Bill To
Name:	___________________________________
Address:	___________________________________
City, State Zip:	___________________________________

Ship To (Enter if different from Bill To)
Name:	___________________________________
Address:	___________________________________
City, State Zip:	___________________________________

Credit Card Number:	___________________________________
Expiration Date:	_____/_____
Phone Number:	___________________________________

QTY	Model	Description	Price

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WI Res Tax:			_________
Total:			_________

Comments:

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