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A&G Liquidators - PO Box 382, Grayslake, IL 60030-0382 |
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Order Form | ||||
| Please read Privacy Statement before you fill in this form | |||||
| About You - | |||||
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| City: | State: Zip Code: | ||||
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| Home Phone: | Work Phone: | ||||
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Your Order Info - | |||||
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Note: All prices are U.S. dollars |
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| Qty. | Part Number | Description | Unit Cost | Ext. Price | ||
| Subtotal: | ||||||
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Shipping & Handling add 4%, $8.95 min.:* |
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Illinois residents add sales tax: |
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| S&H applies to domestic ground only. Air, int'l and oversized shipments will be higher. | TOTAL: | |||||
| Additional comments, extra items or special instructions:
and Billing Address if different |
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| Payment Information - | ||||||
| Payment method: | Discover Master Card Visa Check Money Order | |||||
| Name on card: | ||||||
| Card Number: | CID No.* | |||||
| Expiration Date: | ||||||
* CID number is the 3-4 digit number in the signature strip on back of card.