MBZ Distributing
PO BOX 387
Black Hawk, SD 57718-0387

Phone 605-787-7975
FAX 605-787-7975

ORDER FORM

NAME : ___________________ DEPT : _____________ DATE : _____________

PHONE : __________________ FAX : ______________ PO# : ______________

SHIP:______________________ BILL: ________________________

ATTN:______________________ ATTN:_________________________

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QTY___PART_#______DESCRIPTION___________UNIT PRICE_____EXT PRICE
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SUBTOTAL____________|

SD TAX (6%)____________|

SHIPPING____________|

TOTAL____________|
Shipping:

Single Ball=$2.50
1-500 Balls=$6.50

FOR FASTEST DELIVERY PLEASE FAX IN ORDER!

SAVE THIS ORDER FORM AND COPY FOR EASY ORDERING