Andrew Thompson Company Order Form

Bill to: Company Name:_________________________________________________________________ Contact Person:_________________________________________________________________ Address:_______________________________________________________________________ City:____________________________________State:_________________Zip:______________ Phone: (________)_________________________________________________Ext:___________ Fax:     (________)_______________________________________________________________ E-mail address __________________________________________________________________ Ship to: Company Name:_________________________________________________________________ Contact Person:_________________________________________________________________ Street Address:__________________________________________________________________ City:___________________________________________________State:_______Zip:_________ Phone: (________)____________________________________________Ext:________________

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					Price of Order

Sales tax for Tennessee customers only. Shipping charges are additional; for exact shipping charges, please call us. Method of Payment: MasterCard: # ________________________________________ Visa Card: # __________________________________________ Signature: __________________________________________________________________ Check or money order (US funds only) Purchase Order # __________________________