checkform

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