Everyday 2019-20

REORDER FORM (Please make additional copies for future use.)

Date_________________ P.O. Number__________________ Email Address_________________________________________ Fax #_________________________________________________ Customer #___________________________________________ Phone (Daytime) (_______)______________________________ Phone (Evening) (_______)______________________________ Name of person placing order___________________________ 2. ORDERED BY (Only if different from SHIP TO) Name of Business_________________________________ Division__________________________________________ Street Address____________________________________ City_________________________ State_____________ ZIP Code™___________ Country__________________

800-241-2094 Fax 800-880-9759 Local Fax 706-546-8482 Mail to: burton + BURTON ® 325 Cleveland Road Bogart, GA 30622 USA

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1. SHIP TO Name of Business__________________________________ Street Address____________________________________ City_________________________ State______________ ZIP Code™___________ Country__________________

SECURITY CODE

3. METHOD OF PAYMENT ß Net 30 Attach credit application + authorization form

ß VISA ® ß AMERICAN EXPRESS ® Expiration Date____________________ Signature as it appears on card____________________________________________ Name of Cardholder__________________________________ Bill To________________________________________________ City_________________________ State______________ ZIP Code™___________ Country______________________ ß CHECK Please make check payable to burton + BURTON ® ß CASH Driver will accept exact amount of MONEY. ß CASHIER’S CHECK OR MONEY ORDER ß MASTERCARD ® ß DISCOVER ®

4. ORDER

Product Number

Description

Quantity

Unit Price

Total

1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 May we substitute with similar product if out of any item? ß Yes ß No

Discounts, if any, will be calculated and applied to your order. Shipping and handling charges will be added to your order. Your order will be shipped within 24 hours of receipt of order (not including Saturday, Sunday, or holidays). For additional items, please use another copy of this page. Prices subject to change without notice. Orders subject to acceptance in Bogart, Georgia. Customer consents to the jurisdiction of any court in the State of Georgia and the laws of Georgia.

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