Order Form --- Please type or print.  Fax or mail today!  Fax: 800-806-2038.

Shipping Address -- (No PO Boxes for delivery) Mailing Address: (where credit card statements are mailed)
Company Name


 Company Name
Attention


Attention
Street Address


 		Address
City                                   State              Zip code


 		City                                             State              Zip code
Phone:                                                 Fax:


Phone:                                                 Fax:
Email Address:


 		PO Number
Quantity Model No. Description Color Price Ea. Total
           
           
           
           
Thank You for Your Order! Subtotal  
Florida customers: add state and county sales tax or provide tax exemption number Sales Tax  
           Florida Tax exemption number: Shipping  
Any questions?  Please call, fax or email for assistance. Total  
Method of Payment
Mastercard VISA Amex Discover Shipping charges: Prices do not include shipping charges.  For credit card and open account orders, actual shipping charges will be applied to your order when shipped.  If sending a check, please call or email for shipping charges.  Prices for merchandise are subject to change.  You will be notified of any price changes prior to shipping.
Credit Card Number            Expiration Date            Card Security Code  
                               

 
Card Holder Name:  Please Print
Cardholder Signature


 		Four Easy Ways to Order!
1.  Phone Orders: 800-806-2037 ... 9 a.m. to 5 p.m. Eastern Standard Time,  Monday thru Friday.
2.  Fax Orders:  800-806-2038
3.  On-line Orders: www.displayusa.com
4.  Mail Orders:
      DisplayUSA, Inc.
      PO Box 1486
      Mount Dora, FL 32756-1486
 
____ Check enclosed.  Make payable to DisplayUSA, Inc. in U.S. funds.  Include applicable state and county sales tax (Florida customers only) and shipping charges.  Call or email for shipping charges to your location.
____ Bill Company.  Terms: Net 30 days from invoice date with approved credit application (USA companies only).  Allow extra time for credit approval.