Order Form

Bill To:

Ship To: (if different from billing address)

Note:

If you want to pay us Net 30 days, please fax along your credit references.

Purchase Order Number:

Method of Payment:(circle one)

Visa

MasterCard American Express

Check

Fax: (213) 747-7724

Mail: Roy E. Hanson Jr. Mfg.

Attn. Steve Eszeki
P.O. Box 30507, Los Angeles, CA 90030-0507, USA

Print this form, fill in your shipping and payment information, and send the completed form to us.

Telephone: Steve

( 800 ) 421-9395 ext. 232

or 213 747-7514 ext. 232