JACKSON OFFICE SUPPLIES
Wholesale Company
4622 Femrite Drive, Madison WI 53716
ORDER FORM         Page ____ of ____

Date ordered:________         Needed By: ____________
(800) 598-2736 / Fax: (608) 257-2737
e-mail: info@jacksonofficesupply.com

Billing Address:            
Ship To: (If different than Billing Address)
Company Name: Company Name:
Name: Name:
Address:

Address:
City: State: Zip:  City: State: Zip:

Contact Person: ________________________ E-mail Address: ________________________
Telephone No: (____) ____________ Ext: _____ Website: ______________________________
Fax No: (___) ____________ Ext: _____ Purchase Order Number: _________________
This order is for resale:   Yes ___    No ___
 Special Instructions: ______________________________
Resale No: _____________
________________________________________________
(Wisconsin businesses must provide a Wisconsin Certificate if your order is for resale.)
Item No.
Description
Quantity
Price Each
Total
 
     
   
   
   
 
   
 
 
     
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SUBTOTAL
___________ 
Shipping and Handling is extra... please call for charges.
SHIPPING
___________  
* Sorry, no catalog available at this time.
HANDLING
___________ 
*Wisconsin orders will be charged 5.5% Wisconsin Sales Tax
when the order is shipped.
COD CHARGE ($7.00)
___________ 
Tax Exempt Order   _________________Tax Exempt Number
TOTAL
___________ 

Payment Method      (Please Check One)
___ Check, Please enter check number: _______
Credit Cards: ___ Visa, ____ MasterCard, ____ Amex
___ COD (Additional $6.00 charge)  Print Name As Shown of Card: ___________________
___ Collect  Enter Account No: _________________   Signature of Authorized Signer: __________________
Credit Card Account No: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __    Exp.Date: __________

Shipping Method... please check one: __ UPS,  __ FedX,  __ U.S Postal,  __ Ship Best Way,  ___ Other:
___ Bill To Third Party: Enter Account No: __________________   Billing Account Name: _______________________
___ Standard Ground ___ Next Day ___ 2nd Day ___ 3rd Day