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Bill To:
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Name: Name:
Address: Address:
City: City:
State: State:
Zip: Zip:
Day Phone: Attention:
Attention: Day Phone:
Tax Exempt Number:
$5.50 per set
E-mail:
Quantity:
Description:
Unit Price:
Right-Handed with out Shield
$5.50
Right-Handed with Shield
$5.50
Left-Handed with out Shield
$5.50
Left-Handed with Shield
$5.50
Shipping Information:
up to $20.00..............$4.50
$20.01 to $30.00........$6.75
$30.01 to $50.00........$8.50
$50.01 to $75.00........$10.00
$75.01 to $100.00......$12.50
$100.01 to $150.00....$15.00
over $150.00..............add 10%
Method of Payment:
Purchases order Our terms are Net 30 days for hospitals, schools, and agencies who provide us with a purchase order. Those unable to pay within the 30 day period, must submit a prepaid check with order.
Check or money order
(payable to Milestones)

 

 
 
 
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