Rock-N-Rescue Order Form

ROCK-N-RESCUE
J. E. WEINEL, INC.
P.O. Box 213
Valencia, PA 16059
1-800-346-7673
Fax 724-898-3139

Internet Order Form

Ordered By ________________________________

Address ___________________________________

___________________________________________

City ___________________St ____Zip ________

Purchase Order No. ________________________

Phone Number ______________________________

Fax Number ________________________________

Ship To ___________________________________

___________________________________________

___________________________________________

Mark Shipment _____________________________

Date ______________________________________

E-Mail ____________________________________

Quantity	Item #	Description	Price Each	Total Price













Terms of Sale Governmental, non-profit & others with approved credit 30 days net. All others prepay order, F.O.B. destination. Checks or money orders payable to Rock-N-Rescue. To figure shipping charges, see below. PA residents only add 6% sales tax to subtotal. State laws require us to collect sales tax on shipping. If tax exempt, provide tax exemption certificate.			Sub Total
			Shipping
			PA Sales Tax*
			Total

Check type of payment:

CHECK   MASTERCARD   VISA    DISCOVER    AMEX

Card Number ______________________________________   Exp Date ______________

Card Holder Billing Address if Different then above

__________________________________________________

__________________________________________________

Signature ________________________________________

SHIPPING CHARGES
Ground	6% of Order	Minimum $6.00
2nd Day Air	12% of Order	Minimum $12.00
Next Day Air	22% of Order	Minimum $22.00

NOTE: Oversize items are shipped surface, freight collect.