ORDER / INVOICE SHIPPING FORM
Fax, Mail or Phone in your Order

OLBRO #
________________
Order Date ________________
P.O. No.: ________________

Prices subject to change without notice
Distributor of Gourmet Hot Pepper Sauces, Marinades, BBQ & Spicy Potato Chips 45 Park Lane * Rochester, NY 14625
Tel: (585) 381-9521 * Fax: (585) 248-8292
http://www.olbro.com
Bill To: Ship To:
Address: Address (No PO Box):
City, State, Zip: City, State, Zip:
Phone:  (          ) Attn: Phone:
Payment:      Cash/Money Order ___        On Account ___       Charge ___ (complete next 2 lines)
Visa__  MC__  AmEx__  Disc__  Exp Date: Account #:
Print Cardholder's Name: Signature:
SALESPERSON DATE SHIPPED SHIP VIA TERMS TYPE OF ACCOUNT
         

Item #
Product Description
Price

QTY

Amount

Internal
Use Only
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* Discount Structure
(before shipping & handling)


Subtotal

Discount
$500.00 -- $1199.99 5%
$1200.00 -- or more 10%
Subtotal    
* Less Discount    
Total Merchandise    
Applicable Sales Tax    
Shipping (Actual Charges)    
Handling Charges   $3.00
Total Amount Due    
OLBRO, LLC Appreciates
Your Business!

Received by: ____________________________

Date: ___________