Deluxe Stitcher Order Form




	Easy as 1-2-3! Place your order using our on-line order form and save time and money. If you do not need to speak to a Customer Service Representative simply complete and submit the following form. Confirmation of your order will follow.

Company Name:

Account Number:

Company Address:

City, State & Zip:

Company Phone:

Company Fax:

Company E-Mail:

Purchaser's Name:

P.O. Number:

Special Instructions :

Ship To Address (if different):

Shipping Method:

If Other,
Provide Name of Carrier:

Part Number:

Quantity:

Payment Type: