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Cane & Basket Supply
Co.
1283, South Cochran Ave,
Los Angeles, Ca. 90019.
Phone: (323) 939-9644 Fax: (323) 939-7237
EASY
ORDERING FORM
Please
print out the form to fill it, send it to us by fax or by mail
Name:_________________________________________________________________
Address :___________________________________________________Zip_________
Phone No.__________________Office_________________Other_________________
_______________________________________________________________________
Quantity
Description of Goods
Unit Price
Amount
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
____________________________________________Total
Amount:________________
Payment
by Credit Card: Visa ( )
MasterCard ( ) Diners Club ( )
Credit Card No._______-________- _______ -
_______Expiration Date: ____
/____/
Check No. ___________________
Bank______________________________________
Date:______/______/______
Signature:________________________________
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