Steele Supply Company 3413 Hill Street St. Joseph, MI 49085 U.S.A.
Tel (269) 983-0920 Fax (269) 983-0970 E-mail order@steeles.com http://www.steeles.com

---

Order Form

---

Date:________________

Name:_____________________________________________________

Address:__________________________________________________

City:_____________________State:___________Zip:___________

Phone Number:__________________________________________

---

Quantity Item# Description Price
________ _______ ___________________ _______
________ _______ ___________________ _______
________ _______ ___________________ _______
________ _______ ___________________ _______


Subtotal________________

Shipping________________

Tax (6% In MI)________________

TOTAL________________

---

Method of Payment:

__Check #___________

___Visa ___Discover ___MasterCard

Card Number: __________ __________ __________ __________ Expiration_____________

Name on card (if different than above)___________________________________

Billing Address(if different than above)

Address:__________________________________________________

City:_____________________State:___________Zip:___________

Cardholder Signature:___________________________________


Home