2019-2020 Purchasing Guide Volume 1

COMMERCIAL DIVISION ORDER FORM 2005 E Indian School Rd, Phoenix, AZ 85016 • Order 800.227.8222 • Fax Order 800.537.7838

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1

SHIP TO: (Use only if different address)

BILL TO: (Please print)

Account Name:

Facility Name:

Address: City :

Address: City :

State: ORDER FORM

Zip:

State:

Zip:

Phone #: (

)

Phone #: (

)

Ext:

Ext:

Fax #: (

)

Fax #: (

)

Email:

Email:

Contact Name:

Contact Name:

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Quantity

Item Number

Color

Description

Price Each

Total Price

1 2 3 4 5 6 7

8 9 10 11 12

SUB-TOTAL TAX* SHIPPING

Enclose check, money order, credit card number and/or Leslie’s credit account number and fill out appropriate information below. T Check T Money Order T Visa T MasterCard T Discover T American Express Card #: ________________________________________________________ Signature: _____________________________________________________ Expiration Date: _________________________________________________ Leslie’s Account #: _______________________________________________ Leslie’s Purchase Order #: __________________________________________ 5

4

TOTAL

*Add your state and city sales tax if we ship to: AL, AR, AZ, CA, CT, DE, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, MI, MO, MS, NC, NE, NH, NJ, NM, NV, NY, OH, OK, PA, RI, SC, TN, TX, UT, or VA. If tax exempt, please submit certificate.

THANK YOU FOR YOUR ORDER

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