Mail To:
Frank Beil Company
53 Oceanside Street
Islip Terrace, NY 11752 |
Phone:
(631) 224-3901
Fax: (631) 224-3902 |
| Bill To: |
Ship To: |
Company:_______________________
Attn:___________________________
Address:________________________
City:_____________ST:__Zip:______ |
Company:_______________________
Attn:___________________________
Address:________________________
City:_____________ST:__Zip:______ |
Phone#_________________________
Fax#___________________________
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PO#_________________
Circle: Visa MasterCard American Express
Account #______________________ |
| Signature:________________________ |
Name on Card:__________________
Expiration (MM/YY):______________ |
| Qty |
Mfg Part # |
Description |
Price |
| ______ |
________________ |
________________________________________ |
___________ |
| ______ |
________________ |
________________________________________ |
___________ |
| ______ |
________________ |
________________________________________ |
___________ |
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Sub Total |
$ |
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|
Sales Tax (NY Customers only) |
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|
UPS Shipping & Handling |
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Thank
you for your order!
Total |
$ |
Due to security concerns regarding
ordering over the Internet, we ask that you place all orders via e-mail, fax, or the toll
free numbers (please phone all credit card info).
We accept
Visa, MasterCard and American Express.
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