PnJ Resources, LLC
1124 Liberty Ave.
Beloit, WI 53511
Phone/Fax (608) 365-2925
Email pnjresources@charter.net

                                    ORDER FORM
Catalog#      Description       QTY    Shipping lbs     Price Ea.     Price Total


1)______________________________________________________________________________

2)______________________________________________________________________________

3)______________________________________________________________________________

4)______________________________________________________________________________

5)______________________________________________________________________________

6)______________________________________________________________________________

7)______________________________________________________________________________

8)______________________________________________________________________________

9)______________________________________________________________________________

10)_____________________________________________________________________________

                                                      
        		          Wisconsin Resident Sales Tax x 5%   __________
                                      
                                      Estimated Shipping Charge UPS   __________              
 

Name: ________________________________________________    

Company: _____________________________________________

Address: _____________________________________________

City, State, Zip: ____________________________________  

Phone: (___)_______________                      Email:  _______________________

Payment Method  VISA, MASTERCARD, CHECK, MONEY ORDER                

Exact Name on Card: ________________________________ 

Card #: ________________________________________  Exp. Date: ___/___/_____ 

Signature:  _______________________________________