R.E. Davis Order Form

	R.E. DAVIS CO. P.O. Box 752 Perrysburg, OH 43552 TEL: 419 833 1200 FAX: 480 275 3220	Invoice #________
Name:_____________________________________________ Date: _____/_____/____
Street: ____________________________________________________________________________
City: ________________________ State: ________________ Zip: _________________
Day Phone #: __________________________ Evening Phone #: ____________________

Quantity	Item #	Item Description	Unit Price	Total Price

Subtotal
Ohio residents add 6.5% Sales tax
Shipping & Handling
USPS COD Add $10.00
TOTAL

Circle One:

If out of stock, please: Backorder Cancel

Method of Payment: Cash Check MO COD
Mastercard/Visa/Discover/American Express
Card# _______________________
Exp. date: ____/_____/_____
Credit Card Security Code: _______
(3 digital # on back of card, far right side)

* Shipping & Handling Charges:
Up to $25.00, add $6.00
$25.01 to $45.00, add $8.00
$45.01 to $75.00, add $9.00
$75.01 to $125.00, add $10.00
For each additional $25.00, add $1.00