Please print this form out, fill it out and mail it to the
address listed.
225
West Main Street
St. Clairsville, OH 43950
Phone: 740-699-1111
Fax: 740-699-1112
Email:info@drdspecialty.com
Order
Form
Sold
To______________________________________________
Address_____________City_________State_______Zip______
Attn________________________Email____________________
Phone______________________Fax______________________
Terms:Net
15 days. 1 1/2% per month will be added to past due accounts
Needed
By
______________
Please allow appropriate time.Additional rush charges may
apply
Quantity
Item
Number
Size
or Color
Description
or Title
Confirmation:
Email____ Fax____
Confirmation will contain cost of goods, shipping charges, sales tax
(if applicable), and approximate shipping dates. See
terms and conditions of sales page.
