Mail or Fax to: JOHN STORTZ & SON, INC. 210 VINE ST. PHILADELPHIA, PA 19106 PHONE ORDERS: 888-847-3456 FAX ORDERS: 215-627-6306 RETURN STORTZ HOME PAGE	To Print: Ctrl+P Or Click File…Print EASY ORDER FORM Web Catalog
Bill TO: Name:______________________________ Address:____________________________ ___________________________________ City:_______________________________ State: __________Zip:_________________ Daytime Phone: ( ) _____ - __________ Fax Number: ( ) _____ - __________	Ship To: Name :____________________________ Address:__________________________ __________________________________ City:______________________________ State: __________Zip:_______________ Daytime Phone: ( ) ______-________ Fax Number: ( ) ______-________

Mail or Fax this form, or fill it in for your records when ordering by phone

P.O. # ________________________

	Qty	Item Number	Description	Page	Unit Price	Total Price
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					Subtotal
			(Add 3% for shipping costs)		Shipping
			(PA residents - 6% - Phila. residents - 7%)		Sales Tax