K & J Supply Co., Inc.

115 East Nine Mile Road

Pensacola, FL 32534-0147

1-850-484-7977    or    1-800-360-7473

Fax:  1-850-484-3586

www.kjsupplyco.com

 

 Name __________________________________________ 
Address ________________________________________ 
City ___________________________________________ 
PostCode _______________________________________ 
State ___________________Country __________________ 
Phone __________________________________________

 

Product No.

Item Description

Quantity

Price

Total

 

 

 

$

$

 

 

 

$

$

 

 

 

$

$

 

 

 

$

$

 

 

 

$

$

 

 

 

$

$

 

 

 

$

$

 

Sub Total:

$

METHOD OF PAYMENT

Tax: 

$

PLEASE CHECK APPROPRIATE BOXES

Shipping:

$

( ) Mastercard............. ( ) VISA............. ( ) American Express

 

 

Name on card: _____________________________________ 

Card No. # _________-_________-_________-_________Exp.Date : _________

TOTAL:

$

I authorize you to debit my credit card for the total listed above.

 

Signature ______________________________________________ Date _______________