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Facility *

Name *

Title *

Date

Shipping Address *

City *

   State * 

   Zip * 

Attention

Billing Address

City

    State  

    Zip  

Email

Telephone *

Fax

Purchase Order #

Please complete the following:

Pen Quantity (# dozen) Color Price/dozen Freight Total
YORK #117

Black $5.50

Blue $5.50
YORK CLEAR #646

Black $6.25

Blue $6.25
YORK POLY VINYL FLEX #650

Black $4.95

Blue $4.95
Freight $
Grand Total $ $

For quantities over 200 dozen please call for special pricing

Minimum: 12 dozen YORK #117 and YORK CLEAR #646, 25 dozen for YORK POLY VINYL FLEX #650. Free freight on order of 144 dozen or more. Additional UPS charges will be added where applicable (ie. Hawaii & Alaska).
USPS charges will be added for orders shipped outside of the US.

Check enclosed (Please mail copy of your order with your check)  Send pens on open account (upon credit approval)
Credit Card Visa   MC   Amex
Card Number

Exp.Date

Name on Card

Order Form

        '*' are required fields
 
Facility *
Name *
Title *
Date
Shipping Address *
City *
State *   Zip * 
Attention
  Billing address same as Shipping Address
Billing Address *
City *
State *   Zip * 
Email *
Telephone * ()     
Fax ()     
Purchase Order #

Please complete the following to continue placing your order:
Pen Quantity (# dozen) Color Price/dozen Freight Total
YORK
#117
Black $5.50 $0.00
Blue $5.50 $0.00
YORK
CLEAR #646
Black $6.25 $0.00
Blue $6.25 $0.00
YORK
POLY VINYL
FLEX #650
Black $4.95 $0.00
Blue $4.95 $0.00
Freight $0.00
Grand Total 0 $0.00 $0.00

For quantities over 200 dozen please call for special pricing

Minimum 12 dozen for YORK #117 and YORK CLEAR #646, 25 dozen for YORK POLY VINYL FLEX #650. Free freight on order of 144 dozen or more

Additional UPS charges will be added where applicable (ie. Hawaii & Alaska). USPS charges will be added for orders shipped outside of the US.

  Check enclosed (Please mail copy of your order with your check)
  Send pens on open account (upon credit approval)
Credit Card Visa   MC   Amex
Card Number
Exp.Date
Name on Card



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If paying by check, please mail check and order form to:

326 East 65th Street
PMB 308
New York, NY 10065
USA