Professional Documents
Culture Documents
date: __________________________
ship to: bill to: ( ) Check here if same as “ship to.”
Name Name
Title Title
Company Company
Address Address
City City
State/Zip State/Zip
Country Country
Phone Phone
Fax Fax
E-Mail E-Mail
method of payment: ¤ Mastercard ¤ Visa ¤ American Express ¤ Discover ¤ Check Enclosed (U.S. Bank, U.S. Currency)*
¤ Send Invoice - Purchase Order Number ______________________________ (U.S. Only)
*All payments must be made in U.S. dollars, payable through a U.S. bank to Hydraulics & Pneumatics.
Card Number:_________________________________________ Exp. Date:_________________________________________