Order Form

Date: (mm/dd/yyyy)
AMERICAN HOMETEX, INC.
2540 Station Dr #B
Stockton, CA 95215

Ph: 209-466-1868
Fax: 209-466-1789

www.americanhometex.com
     
Customer # : Purchase# :
Sales Rep. :
Phone : Fax :
Contact :
Bill To :
Ship To :
Ship Method:
Ship Date :
Resale Number :
Email :

    Terms:
                        


    If Take Credit Card :
    

    

    

Exp Date :

(mm/yyyy)

Credit Card# :

 

ORDER

Product Name:

Item Number:

Size:

Price:

Qty:

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Shipping Total: Total Total
 
   
   
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