Jacobs Online

PO Box 327

Moxee WA 98936

 

Order Form

sales@jacobs-online.biz

Phone 509-949-2466

 

Note:  This order form is for mailing
For online orders, please use:

 "Add to Cart" Buttons

Ship to:

 Name_________________________________________________________

 Address_______________________________________________________

           _______________________________________________________

City ________________________________ State ______,  Zip __________

Phone Number (required) _________________________________________

Email Address __________________________________________________

 

Qty

Cat No

Item/Description

Price/

Item

Subtotal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sub Total

  

Sales Tax

 (Washington State Residents add 7.9%)

 
Total

 

Shipping Charge

(Contact Jacobs Online for shipping charges)

 
Amount Due

 
 

Add additional sheet for more items