Farmer-Boy-catalog - Catalog - Page 376
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Order Form
Parts & Supply Order Form
Customer #
Item #
Page #
Description
Quantity
Unit Price
Total Amount
Subtotal
Add applicable Sales tax
in effect for ship-to-address (AK, IL, IN, KY, MD, MI,
MN, MO, NC, NE, NJ, NY, OH, PA, VA, WI, WV only
Payment Method:
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Visa
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Mastercard
Name on Card
____________________________________
Card #
____________________________________
Exp. Date
_____/_____
Customer #
_________________
SHIPPING (Call for quote)
Discover
Total Amount Enclosed
Sec Code _________
Signature _______________________
Billing Address:
Ship To Address (if different than billing)
Name
____________________________________
Name
Street Address
____________________________________
Street Address
____________________________________
City
_______________
City
_______________
Phone
(____) _____-________
State _________
Zip _________
Email _______________________
____________________________________
State _________
Zip __________
Mail Form To: Farmer Boy
50 W Stoever Ave, Myerstown, PA 17067
Or Fax to: (717) 866-9072 Or Email to: info@farmerboyag.com
Please Check Box Where Applicable
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Please send the address portion of this catalog’s
back cover with your updated address. We will
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Help us eliminate duplicate mailings. If you
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same address, please notify us by mailing back
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portion of the back cover with a note requesting
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372
Toll Free Order Line: 800-845-3374
