JSDIST.com
- Order Form
JSDIST.com
- Order Form
Print out form, add information .... mail or fax.
27 STONE HILL ROAD • OSWEGO, IL 60543
• Toll Free: 1-866-619-6385 • Fax: (630)
554-1198
Customer Name:
Street Address: Suite# / Apt# or Attn:
City / State / Zip:
Telephone #: Fax #:
E-Mail Address:(for notifiaction of shipping and UPS tracking #)
Qty Item # Desc Price Ea. Amount
Qty Item # Desc Price Ea. Amount
Qty Item # Desc Price Ea. Amount
Qty Item # Desc Price Ea. Amount
(Effective June 6, 2005, $15.00 Minimum Merchandise Order Requirement) Merchandise Total:$
Sales Tax for Illinois customers - Add 6.75% to Merchandise
total: $
Shipping charges are configured at a flat rate amount ... Based on the total
amount of your purchase.
To figure a multiple item order, use the following schedule.
$0.01 to $19.99 = $7.00 shipping
$20.00 to $49.99 = $8.00 shipping
$50.00 to $99.99 = $12.00 shipping
$100.00 to 199.99 = $15.00 shipping
$200.00 to $300.00 = $20.00 shipping
Above $300.00 = Call for pricing.
Shipping Charges Total: $
Order Total
with shipping & taxes $
Credit Card: MasterCard
VISA Discover
American Express
Check
(Personal and Company checks will take several extra days to clear
before order ships)
Credit Card #:
Expiration: (Mo/Yr)
(If name on credit card and/or billing address is different than
ship to, please insert that information below)
Comments / Additional Instructions:
We
accept: 
/ secure payment via PayPal Payment Services.
All items are subject to Manufacturer's availability and production.
We reserve the right to refuse any order(s) placed for any reason.
Prices are subject to change without notification.
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