Craft Beer Equipment-BE0120

CARD NUMBER EXP. DATE (MO/YR) SECURITY CODE (3 OR 4 DIGITS) GOVT. CARD VISA AMERICAN EXPRESS MASTERCARD 1-800-563-8848 24 hour FAX John M. Ellsworth Co., Inc. P.O. Box 240072, Milwaukee, WI 53224 MAIL 1-800-333-3331 8:00 a.m. - 5:00 p.m. (C.S.T. Mon. - Fri.) PHONE ACCOUNT # COMPANY NAME NAME/TITLE ADDRESS CITY STATE ZIP FAX EMAIL SIGNATURE TELEPHONE ( ) DATE / / ORDER # We must have your signature and telephone number to process this order. We cannot ship to a P.O. Box. Please print clearly. Photocopy this page to use more than once. CARD HOLDER NAME SIGNATURE ADDRESS CITY STATE ZIP PAYMENT ENCLOSED In the amount of $ ____________ Check or Money Order Only BILL US We have a JME Account Acct # ______________ CREDIT CARD Fill in information below CHECK ONE PAYMENT METHOD BILL TO SHIP TO ORDER FORM PART # DESCRIPTION PAGE QTY UNIT UNIT PRICE EXTENDED (INCLUDE SIZE, WEIGHT & COLOR) # (EA., DOZ, ETC.) (EA., DOZ, ETC.) TOTAL SALES TAX* SHIPPING** TOTAL * Sales Tax applies to Wisconsin residents ONLY. ** Shipping charges will be pre-paid and added to invoice. Please call for an estimate if you are mailing a check with order. Order Form JME Sanitary Catalog TERMS & CONDITIONS ON PREVIOUS PAGE COMPANY NAME ATTN: ADDRESS CITY STATE ZIP