Burhop Box & Packaging - Order Online

SOLD TO:		SHIP TO:
Burhop Cust. #		Company Name
P.O. Number		Contact/Title
Company Name		Street Address
Buyer's Name/Title		City
Street Address		State
City		Zip
State
Zip
Phone
Fax

ORDER INFORMATION

QTY. STOCK
NUMBER DESCRIPTION
(Include size if several applicable) UNIT PRICE TOTAL PRICE

SUBTOTAL

TAX*

TOTAL

*IL & MN 6.5%; NJ 6%; CA 7.75% Orange City. 7.25% other.

METHOD OF PAYMENT

Burhop Account. Bill me net 30 days.
Check Enclosed. Visa MC
Card # Exp. date

FOR NEW CUSTOMERS

D&B #
IF NOT LISTED WITH A DUN & BRADSTREET, PLEASE COMPLETE THE FOLLOWING:
SIC.Line of Business
Bank Name Phone #
Bank Checking Account #: