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DICKSON
Step 1 - Bill To:
Name
Company
Address
City
State Zip
Phone ( ) –
Email
Step 2 - Ship To (if different than above)
Name
Company
Address
City
State Zip
Phone ( ) –
Email
Step 3 - Ordering Information
Order # Quantity Price/Unit Total
$ /each $
$ /each $
$ /each $
$ /each $
Subtotal: $
In Illinois, add 7.5% sales tax 4 Tax: $
Freight: $
All Prices in U.S. Dollars 4 Total: $
Step 4 - Payment Method
Check: Check #
Money Order
Credit Card:
Credit Card Number: Expires: (mm/yy)
– – – /
Signature
Purchase Order: P.O.# (Net 15 days for established customers)
Customer #:
U.S.A. Freight Charges
Fax to: 1-800-676-0498 Mail to: Dickson, 930 S. Westwood Ave, Addison, IL 60101
Total Order UPS 2nd Day UPS Next UPSGround
$0-100 $16 $33 $10
$101-400 $20 $42 $15
$401-700 $28 $57 $18
$701-1,000 $37 $60 $26
$1,001-1,500 $56 $77 $39
$1,501-2,000 $74 $97 $46
$2,001-over Please call Dickson Customer Service
All shipments UPS 2nd day unless otherwise requested.