PRINT OUT ON YOUR PRINTER AND CUT HERE
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Payments
To:
Ship To:
Brooklyn
Express
Customer Name:
Phone No.
1350
Hwy. 33 / 34, Store#23 Aisle 2
Street Address:
Farmingdale,
NJ 07727
City:
State:
Zip:
Prod. Color
Discription
Item
Size
Price
Each
Quant.
Total
Price
Ordering Instuction:
Print and fill out this form. Add 6% For NJ Resident.
Businesses Must Enclosed A Copy Of Their Tax ID Paper.
CHARGE CARD
INFORMATION
__ Money Order Inclosed
__ Master Card
__ American Express
__ Discover Card
__ Visa Card
__ Certified Check
Card Exp. Date: ________________________________
Credit Card No: ________________________________
Sinature: _____________________________________
6% NJ SALES TAX ______
CALL FOR
SHIPPING COSTS ________
ORDER
TOTAL _________
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CUT HERE Please Print This Form Out On Your
Printer!
Fill It Out And Mail With Payment, To Brooklyn Express.
Make Check Or Money Order Payable To "Brooklyn Express"
1350 Hwy. 33 / 34, Store#23 Aisle 2 - Farmingdale, NJ 07727
