Plastruct, Inc. - Consumer Form

			Consumer Order Form
			These Order Forms are designed to be printed on paper, filled in manually and forwarded to PLASTRUCT INC. • 1020 S. Wallace Place • City of Industry, CA 91748. They are not designed for online ordering. We recommend you print these pages at 75% of full size. See our Order Information Page for assistance on where and how to place your order.

NAME ___________________________________________________________ DATE ____________________

ADDRESS ________________________________________________________

CITY ____________________________________________________________

STATE _________ ZIP ___________________ DAY PHONE _______________________________

PAYMENT METHOD

  ENCLOSED IS MY CHECK OR MONEY ORDER PAYABLE TO PLASTRUCT.
  SHIP MY ORDER C.O.D.   A $9.00 FEE WILL BE ADDED.
  CHARGE TO MY CREDIT CARD.
              VISA                 MASTERCARD

CARD NUMBER _____________________________________________ EXPIRATION DATE ___________

CARD HOLDER'S NAME ___________________________________________

SIGNATURE ____________________________________________________

PRODUCT CODE	QUANTITY	PRODUCT DESCRIPTION	SCALE/ SIZE	LENGTH	PRICE EACH	TOTAL

SUBTOTAL (THIS SHEET) __________

( Please Note: $20.00 Minimum Order) SUBTOTAL (OTHER SHEETS) __________

SALES TAX (CA RESIDENTS ONLY) __________

POSTAGE & HANDLING (SEE ORDER INFORMATION) __________

TOTAL ORDER AMOUNT __________