FlagHouse, Inc./PE Central Order Form
601 FlagHouse Drive, Hasbrouck Heights, NJ 07604
Phone: 800-793-7900; Fax: 800-793-7922

For security purposes,
DO NOT e-mail credit card orders

SHIP TO: (Please indicate street & number. We can't deliver to a P.O. box.)

Organization:

Address:

City:

State:

Zip:

Phone:

Fax:

Name:

Title:

BILL TO: (Fill in only if different than above.)

Organization:

Address:

City:

State:

Zip:

Phone:

Fax:

Name:

Title:

Your PO #:

Date:

Deliver By:

Your Signature:

Do Not Ship Before:

QTY

Item #

Description
(Include Color, Size, and Other Needed Info)

Unit Price

Total

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

NY, NJ & Calif. Customers Only: Sales Tax will be charged unless Exemption Certificate or Number is supplied:

We are Exempt: _____
Certificate Enclosed: _____
Exempt #: __________

Payment Method: (Circle One)

AMEX

VISA

Master Card
Card Holder's Name: ____________________________

Account #: ____________________________

Expiration Date: ______________

Subtotal

-

NJ, NY & Calif. only
Add Sales Tax

-

S & H:
Minimum of $15 or 13% whichever is greater

-

Add $30 if ordering any Truck Ship (non UPS items)

-

Total

-

Trade Name: _______________

Tel: ________________

Contact Person: ___________________

Trade Name: _______________

Tel: ________________

Contact Person: ___________________

Bank Name: _______________

Tel: ________________

Acct. #: _________________________

Address: ________________________________________ Signature: ________________________