ORDER FORM FOR NORSTAR DISTRIBUTORS

This form is provided for customers who prefer to order our products via fax or the United States Postal Service.  Please print the form, then complete the ordering information using a typewriter or legible print.

Mail to:     Norstar Distributors                                                 Fax to:        813-929-0293
                   P O Box 575
                   Attention: Sales Department                                 Telephone:  813-929-0273
                   Land O' Lakes, FL 34639-0575                                Toll Free:     877-929-0273              
 
CUSTOMER INFORMATION:

Name: ___________________________________
Company: ________________________________
Department:  ______________________________
Address: _________________________________
Suite/Apt: ________________________________
City: ____________________________________
State:______________   Zip:  ________________
Telephone: _______________________________
Fax:  ____________________________________
Email: _______________________________________

   SHIPPING INFORMATION:

Name:  __________________________________
Company:  _______________________________
Department: ______________________________
Address:  ________________________________
Suite/Apt:  _______________________________
City:  ___________________________________
State: ______________   Zip:  _______________
Telephone:  ______________________________
Fax:    __________________________________
Email:  __________________________________

Product Code

Product Name

Description

Size

 Quantity

Price Each

Total Cost
             
             
             
             
             
             
             
             
             
             
Method of Payment:  Note: Merchandise Total:  
American Express    Florida Sales Tax, if Applicable  
MasterCard  Tax Exempt Number:  
Visa  Shipping:  
Money Order  Promotional Code, if Applicable:  
Travelers Check  Other:  
Company Check /Approved Accounts Only  Total Order:  
Account # 1111111111111111 Signature of Person Authorizing Order
Expiration Date:  Month 11 Year 1111 Sign Here:
Name on Credit Card: Print Name:

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