Orderform

John's Floorcovering Co., Inc.
218 S. Caroline Street Herkimer, NY 13350 * Phone (315) 866-6681 * Fax (315) 866-4529
(Print this form, fill it out and fax it to us)

Ship To:		Mailing Address:
Name:	____________________________	___________________________________
Address:	____________________________	___________________________________
Payment Made By:
Check:	Amount Enclosed $______________	E-mail: _________________________
Credit Card Type _______________________		Home Phone: ____________________
Card # ________________________________		Work Phone: ____________________
Exp._____________ Date Order ______________

Item Name:	Description:	Color:	Qty:	Unit Cost:	Total Amount:
________________	______________	___________	______	__________	$
________________	______________	___________	______	__________	$
________________	______________	___________	______	__________	$
________________	______________	___________	______	__________	$
________________	______________	___________	______	__________	$
________________	______________	___________	______	__________	$
________________	______________	___________	______	__________	$
________________	______________	___________	______	__________	$

		Sub Total:		$____________
_______________________________________________		Shipping Charges:		$____________
Ordered By (Signature)		Handling Charges:		$____________
		Insurance:		$____________
	Tax Rate:	_____ %	Tax:	$____________
		Total Due:		$____________