Order Form

Bill To:

Ship To: (if different from billing address)

Note:

If you want to pay us Net 30 days, please fax along your credit references.

Purchase Order Number:

Method of Payment:(circle one)

Visa

MasterCard American Express

Check

Fax: (213) 747-7724

Mail: Roy E. Hanson Jr. Mfg.

Attn. Steve Eszeki

1924 Compton Ave.
Los Angeles, California 90011

Print this form, fill in your shipping and payment information, and send the completed form to us.

Telephone: Steve

( 800 ) 421-9395 ext. 232

or 213 747-7514 ext. 232