Master Catalog 2016-17

Reorder Form (Please make additional copies for future use.)

Date P. O. Number Email Address Fax # Customer #

✂ ✂ ✂

800-241-2094 Fax 800-880-9759 Local Fax 706-546-8482 Mail to:

Phone (Daytime) ( ) Phone (Evening) ( ) Name of person placing order

burton + BURTON ® 325 Cleveland Road Bogart, GA 30622

1. SHIP TO Name of Business Street Address City State ZIP Code™ Country

2. ORDERED BY (Only if different from SHIP TO) Name of Business Division Address City State ZIP Code™ Country

3. METHOD OF PAYMENT ❑ VISA ® ❑ MASTERCARD ® ❑ DISCOVER ® ❑ AMERICAN EXPRESS ® Expiration Date Signature as it appears on card Name of Cardholder City State ❑ CHECK Please make check payable to burton + BURTON ® Bill To ZIP Code™

Country

❑ CASH Driver will accept exact amount of MONEY .

❑ CASHIER’S CHECK OR MONEY ORDER

4. ORDER

Description

Product Number

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? ❑ Yes ❑ 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. Total number of pages being transmitted including this sheet