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Name
Company
Address
City
State
Phone (
)
Email
Name
Company
Address
City
State
Phone (
)
Email
Order #
Check: Check #
Money Order
Credit Card:
Credit Card Number:
–
Purchase Order: P.O.#
Customer #:
Total Order
$0-100
$101-400
$401-700
$701-1,000
$1,001-1,500
$1,501-2,000
$2,001-over Please call Dickson Customer Service
All shipments UPS 2nd day unless otherwise requested.
Mail to: Dickson, 930 S. Westwood Ave, Addison, IL 60101
Step 1 - Bill To:
–
Step 2 - Ship To (if different than above)
–
Step 3 - Ordering Information
Quantity
Price/Unit
$
$
$
$
In Illinois, add 7.5% sales tax
All Prices in U.S. Dollars
Step 4 - Payment Method
–
–
Signature
U.S.A. Freight Charges
Zip
Zip
Total
/each $
/each $
/each $
/each $
Subtotal: $
Tax: $
4
Freight: $
Total: $
4
Expires: (mm/yy)
(Net 15 days for established customers)
UPS 2nd Day
UPS Next
$16
$33
$20
$42
$28
$57
$37
$60
$56
$77
$74
$97
/
UPSGround
$10
$15
$18
$26
$39
$46