FAX ORDER FORM

To: Plastic Products Mfg.
Fax: 714-524-8145
Attn: On line Sales Dept.
Contact us at www.plasticproductsmfg.com 		3810 Prospect Avenue, Bldg C
Yorba Linda, CA 92886
Toll Free: 800-611-6466
Email: sales@plasticproductsmfg.com
Date: _____________  Order  Request Quote  Request Information  Request a Sample
To place an Order, Request a Quote, Information or a Sample, please provide the following information below. Fields marked with asterisks (*) are required.

How did you hear about us? ____________________________________________________________________
Bill To:

* Your Full Name: ____________________________

* Company Name: ______________________________

* Address: ___________________________________

* City: ______________________________________

* State: ______________ Zip Code: ____________

* Phone: _____________________________________

* Email Address: _____________________________

* Fax: _______________________________________

* Credit Card Number: ________________________

* Card Type: _________________________________ 		Ship To:

Contact Name: ________________________________

Company Name: ________________________________

Address: _____________________________________

City: ________________________________________

State: ______________ Zip Code: ______________

Phone: _______________________________________

Email Address ________________________________



* Expiration Date ____________________________

* Card Security Code: ________________________

IMPORTANT: Billing information above must be the same as your credit card statement address. If you don't provide the correct billing address, chances are the order will not be processed.
Item Number Description Quantity Price each Total Price
1. _____________

2. _____________

3. _____________ 		_____________________________

_____________________________

_____________________________ 		____________

____________

____________ 		___________

___________

___________ 		____________

____________

____________

SHIPPING METHOD

 UPS  FedEx  Common Carrier (Truck)
 Regular Ground  Overnight  2nd Day Air  3 Day Select
(sorry, we cannot ship to a P.O. Box)
Upon receipt of your completed fax order form, we will contact you via e-mail to confirm your order and advise you of product availability.

I understand that I must inspect my order immediately upon receipt and notify Plastic Products Mfg., within 24 hours of delivery, of any damage or shortages.


Authorized Signature _______________________________________