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Please Print, Fill In, and Mail
This Form to:

Discount Van-Truck
PO Box 13075
Long Beach, CA 90803

Business Name  
Contact Name  
Street Address  
City,State,Zip  
Phone  
Fax  
e-mail  
Purchase Order  
Check Number  

Quantity
Stock #
Destiption
Price
Item Total
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         

Please call 800/414-0485
for shipping & handling
tax amout (if any)
.
Total Net
 
Tax (if any)
 
Shipping & Handling
 
Total