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Quick Order Form
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MINIMUM ORDER $15.00 IN MERCHANDISE *
* Open Account Orders: $50.00 Minimum in Merchandise
* International Orders: $100.00 Minimum in Merchandise
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To expedite your order please include a phone number.
Please type or print all information.
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Bill To:
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Ship To:
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Full Name
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Full Name
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Address (or PO Box)
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Address (or PO Box)
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City, State, Zip (Postal Code)
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City, State, Zip (Postal Code)
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Phone Number
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Phone Number
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Email Address
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Email Address
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Products:
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All items are new unless otherwise noted
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H&R STOCK NUMBER
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DESCRIPTION
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QTY
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UNIT
PRICE
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TOTAL
PRICE
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Subtotal
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Shipping & Handling:
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Applies to shipments within continental U.S.
Rates include shipping, handling and insurance.
| Merchandise Total |
UPS Ground |
| $ .01
to $24.99 |
$8.20 |
| $25.00
to $34.99 |
$9.25 |
| $35.00
to $54.99 |
$10.30 |
| $55.00
to $94.99 |
$12.40 |
| $95.00
to $119.99 |
$14.55 |
| $120.00
to $194.99 |
$18.75 |
| $195.00
to $499.99 |
$22.45 |
| $500.00 and over |
$28.00 |
- Special shipping or freight charges, supersede these regular
shipping charges.
- Individual orders over 10 pounds may be subject to extra charges.
- There are extra charges for AK, HI, PR, Canada, and priority
shipping services.
- For special shipping charges, please contact our Customer
Service Department at (856) 802-0422
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Shipping & Handling Charge
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Processing:
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Cash/Credit
Card Orders Under $15.00, add $5.00
Open Account Orders Under $50.00, add $10.00
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Processing Charge
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Sales Tax:
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Applies to all sales picked up or delivered in NJ.
Customers with valid NJ resale certificates are exempt.
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| NJ Sales
Tax (7%) |
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Order Total:
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Total Amount Due
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Payment Information:
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Payment Method
(please circle one)
Check Enclosed
Money Order Enclosed
Visa
Master Card
Discover
Credit Card orders, please fill in the following:
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Card Number
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Expiration Date
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Name on Card
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Signature
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Thank You for Your Order!
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