GENERAL CATALOG ORDER FORM
D.J. MINERALS, INC.
P.O. Box 761
Butte, MT 59703-0761
PHONE: 8:00 am - 5:30 pm (MOUNTAIN TIME) (406) 782-7339
FAX: (406) 494-2455
| SHIP TO: (Street Address) | ORDER DATE:
|
DATE NEEDED: | ||
| YOUR ORDER NUMBER: | SHIP VIA:
|
|||
| PPD | COD | |||
| TERMS NET 30 DAYS | F.O.B. BUTTE, MT | |||
| PHONE NUMBER:
|
CONTACT PERSON: | |||
| QTY. | CATALOG # | DESCRIPTION and SIZE | UNIT PRICE | TOTAL |
PAGE TOTAL: $_____________
ORDER TOTAL: $_____________
SHIPPING: $_____________
TOTAL: $_____________