Bill To
:
Ship To
:
Date: PO#: Phone: Fax:
Check One The Above Ship to Address is: Residential___ Commercial__
Item Description Size Quantity Price Each Price Extended
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
-
Sub Total
-
Freight Charge
-
Total
-
Account Number:___________ Visa__ Discover__ M/C__ AMX__
Signature:__________________ Date:________ Expiration Date:____MO____YR
Check/Money Order
We do not accept cash or COD orders
Minimum Order
Shipped $25.00

Plexi Fab 1142 E. Elm Ave. Fullerton, CA 92833
(714) 447-8494 * (714) 738-1142 Fax