Page 65 - 2016-2017 Biedermann & Sons Inc. Full Line Catalog
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Biedermann & Sons Inc. USE THIS SPACE FOR SPECIAL SHIPPING INSTRUCTIONS
190 NORTHFIELD ROAD • NORTHFIELD, ILLINOIS 60093
Phone: 800.446.8150 • FAX: 847.446.8528 • www.biedermannandsons.com
DATE: _____________________
BILL TO: _________________________________________________________________________________ STREET: _________________________________________________________________________________ CITY/STATE/ZIP CODE: _________________________________________________________________ PHONE: __________________________________ BUYER.: ______________________________________ TAX ID OR RESALE #: __________________________________________________________________ SHIPPING DATE: _______________________ SALESMAN: ___________________________________ Mastercard_______Visa_______Discover_______AMEX_______Exp. Date: __________________ Cardholder’s Name: ____________________________________________________________________ Cardholder’s Address: __________________________________________________ Zip: ___________ Card #: ______________________________________________________________ Sec #:___________ Cardholder’s Signature: ________________________________________________________________ Email Address: _________________________________________________________________________
SHIP TO: __________________________________________________________ RESIDENCE: Yes
No
STREET: __________________________________________________________________________________ CITY/STATE/ZIP CODE: __________________________________________________________________ HOW SHIP: ______________________________________________________________________________ CUSTOMER ORDER NO: ________________________________ BACKORDERS: Yes No
Quantity
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Catalog No.
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Description
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Cost
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Amount
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Quantity
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Catalog No.
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Description
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Cost
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Terms: Net 30 THANK YOU!
Total Column 2
Total Column 1
Total Amount of Order
Amount
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Total Column
7A
