PRINTABLE ORDER FORM 1st Army Supply Inc

PRINTABLE ORDER FORM
1^st Army Supply Inc.

310 W. Roosevelt Rd.

Lombard, Illinois 60148

Phone: 630-916-7380

Fax: 630-916-7389

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PERSONAL INFORMATION

Full Name: _____________________
Address:   _____________________
           _____________________
           _____________________

Email:     _____________________
Phone:     _____________________
Fax:       _____________________

Payment Type: (Check One)
[ ] Credit Card
[ ] Cashiers Check

Shipping Information:
Please see the store policy section on our website to calculate shipping charges.

Select a Method:
[ ] Standard Ground
[ ] 2-Day Priority
[ ] Next Day Priority

Subtotal: $______
Shipping: $______
(Illinois Only 7.75%) Tax: $______
Total: $______

CREDIT CARD INFORMATION (if applicable)

Card Type: (Check One)
[ ] Visa
[ ] Master Card
[ ] Discover / Novus
[ ] American Express

Name on Card: ______________________

Card Number: ______________________

Expires: ___ / ___

Signature: X_____________________

DISCLAIMER

1^st Army Supply does not warrant that you may legally purchase, own or carry specific products offered in our catalogs. When you place an order with us for products that may have restrictions, you warrant to us that you are a legal adult (18 years or older) without legal disabilities and are in compliance with local, state and federal laws. Hazardous items (such as knives) will require an adult's signature upon delivery.

I ____________________ agree to these terms.
(Print Name)

X____________________    _________
   (Sign Name)                (Date)