Bill to: Ship to:(if different)
Business/Name:
Billing Address:
City, State, Zip:
Phone: () Fax: ()
Contact Person:
Email Address:
Business/Name:
Shipping Address:
City, State, Zip:
Phone: () Fax: ()
Contact Person:

If You Have A Bar Boy Products Catalog Fill In Page #’s and Item #’s For Price Quotes - Fax to 516-293-7984
CODE SHORT DESCRIPTION QTY PRICE

Shipping charges: $15.00 - $39.00 (depending on weight) will be added to your order. You will be notified about orders requiring larger freight charges. You will be called, faxed or mailed order acknowledgement with final totals including shipping charges if over $39.00. Please review carefully, sign and re-fax to 516-293-7984 Before Shipments.
TERMS REQUESTED (Please Check One)
Credit Card Order (Fill out CC Information Below)
Payment in Advance (Includes: Money Order, Cashier’s Check, or Certified Check.)
Business Check in Full Enclosed (you must use the print amd mail Method below)
Open Accounts - Fill in Account Number (If Known):
New Customers Send for Application via e-mail
(Allow 30 business days to process new account application.)
Credit Card Payment Information:
Payment Type: Visa MasterCard American Express
Credit Card Number: exp:
ORDER METHOD : Via Email Via Fax or print form and mail to us (Required for Business Check option)
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