Woodsmans International
Retail Store Purchase Order
Please fill out the form below and click the [ Next ] button.
The information you enter on this form MUST match your Credit Card EXACTLY; as well as your delivery address.
Store Information:
*
Store Name :
*
Store Number :
*
PO Number :
Shipping Address :
Shipping City :
Shipping State/Province :
Shipping Postal Code :
Order Contact Information:
First Name :
Last Name :
Email Address :
Phone Number :
Liqui-Fire: Thaws Frozen Pipes : Product Selection:
Retail Invoice Product :
A 12 bottle box = $227.88 or $18.99 each
A 6 bottle box = $116.94 or $19.49 each
A 2 bottle box = $39.98 or $19.99 each
Product Quantity :
Bill To Store :
Billing Information:
Head Office Name :
Accounts Payable :
Billing Phone Number :
Fax Number :
Billing Email :
Billing Address :
Billing City :
Billing State/Province :
Billing Postal Code :