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

Discount Van-Truck
7601 Ramish Ave
Bell Gardens, CA 90201
Business Name  
Contact Name  
Street Address  
City,State,Zip  
Phone  
Fax  
e-mail  
Purchase Order  
Check/MO Number  
 
Qty
Stock #
Destiption
Size
Color
Price
Item Total
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
Please call 800-414-0485 or 800-884-3826 for shipping cost.
California orders add 9.25% sales tax.
Total Net
 
Tax (if any)
  
Shipping
 
Total