Security and Safety Products
720 Montauk
Highway, Copiague, NY, 11726
Telephone: 1 800
645-4443 OR (631) 226-1541 ~ Fax: (516) 226-1259
TO JUST PRINT THE ORDER FORM : RIGHT CLICK - THEN PRINT !
Customer Name ____________________________________ Business Name _______________________
Address
_______________________ Apt # _______ City _______________________ Zip ____________
_
SHIP TO - same as above ________ -OR- TO
_______________________________________________
City ______________________________ Zip ____________
Phone # Daytime - (___) _____-________ FAX (___) _____-________
E-mail Address ______________________________________ Our e-mail :
promarkint@aol.com
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Sub total $ _____ |______
Comments: NY residents add Sales tax $
_____|______
Shipping & Handling - each $
Grand total_ $______|_____
o
Visa o
MasterCard
o Check or Money order enclosed
Card Number____________________________________
Name on card___________________________________
Billing Address ____________________________
Exp. Date_____/____
Signature______________________________________
Thank You for your order.