Page 63 - KieferAuctionSupply Animated Catalog 2016-17

ORDER FORM
417 W. Stanton
Fergus Falls, MN 56537 Phone: 218.736.7000 Fax: 218.736.7474
HOURS 7:30AM - 5:00PM MONDAY - FRIDAY
ORDER ONLINE ANYTIME www.kiefersauctionsupply.com
(Last Name)
Zip
Ordered By:
Business Name
(First Name)
Street Address
City
Email Address (If Available) Daytime Phone
1 2 3 4 5 6 7 8 9
10
(Middle Name)
State
Payment Method:
Check:  I’ve enclosed a check or money order payable to Kiefer Supply, Inc.
Merchandise Total
Sales Tax (MN 6.875%) (ND 5%) All others no tax
Shipping & Handling Added to order
TOTAL
Please charge my:  MasterCard  Visa  American Express Acct. # I__I__I__I__I__I__I__I__I__I__I__I__I__I__I__I__I__I
Print Card Holders Name: Signature:
 Discover Exp.
Fax Number Evening or Cell
CODE
QTY
DESCRIPTION
UNIT PRICE
TOTAL AMOUNT
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218.736.7000
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