PaintSupply.net Order Form

Print this form out, complete it, and fax or mail it to us!

Fax Order Number: (850) 653-8064
Mailing Address: 
Universal Shopping Center
P.O. Box 412
Apalachicola, FL 32329

Personal checks are accepted by mail.

Name___________________________________________________________

Address________________________________________________________

City_________________________________ State______ Zip__________

Phone #________________________FAX #___________________________

E-Mail______________________________

Credit Card Type (check one):

Visa___ MasterCard___ Discover___ Amex___

Credit Card Number_____________________________________________

Expiration Date (mm/yy)__________________

Signature______________________________________________________

Part #             Description              Quantity   Unit
                                            Ordered    Price    

_______   ______________________________     _____     _________

_______   ______________________________     ______    _________

_______   ______________________________     ______    _________

_______   ______________________________     ______    _________

_______   ______________________________     ______    _________

                                            Subtotal   _________

                 Florida Residents, Add 6% Sales Tax   _________

     					    Shipping:  _________

                     Order Total   _________

Your order will ship via UPS, usually the next
business day after receipt.

Questions? E-Mail: sales@paintsupply.net

Thanks for your order!