2xlcorp.com

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Bill To:

First Name:

Last Name:

Company:

Address:

Address 2:

City:

State:

Zip Code:

Phone:

Fax:

Email:

Date:

Ship To:

First Name:

Last Name:

Company:

Address:

Address 2:

City:

State:

Zip Code:

Phone:

Fax:

Email:

Date:

Purchase Order Number:

Facility Name:

Product To Order:

Quantity:

Product:

Monthly

Bi-Monthly

Quarterly

Yearly

Quantity:

Product:

Monthly

Bi-Monthly

Quarterly

Yearly

Quantity:

Product:

Monthly

Bi-Monthly

Quarterly

Yearly

Quantity:

Product:

Monthly

Bi-Monthly

Quarterly

Yearly

Shipping Options:

Beginning of the Month

Middle of the Month

Start Date:

Signature:

(I am instructing 2XL to ship and invoice)

NOTE: Cancellation or Changes must be done 2 weeks prior to order shipment.
Less than 2 weeks notice will result in customer being responsible for all shipping fees.

â‡’ Note: Please fax back any address corrections to 2XLCorp at: 708 344-4095 â‡

Payment Method:

Credit Card Type:

Name On Card:

Credit Card Number:

Credit Card Security Code:

Expiration Date: