Internet Fax or mail to: Web Page B&A Industrial Products ORDER FORM 700 East Shawntel Smith Blvd P.O. Box 1376 Muldrow, OK 74948-1376 Phone 918-427-3600 Fax 918-427-3214 SOLD TO SHIP TO (if different) Name _____________________________ ______________________________ Company __________________________ ______________________________ Address __________________________ ______________________________ City/St/Zip ______________________ ______________________________ Phone ( ____ ) ___________________ Date of order ________________ Email address: ___________________________________________________ Special shipping instructions: ___________________________________ Other: ___________________________________________________________ Qty Stock # Description Price Amount _____ ________ _______________________ ________ _________________ _____ ________ _______________________ ________ _________________ _____ ________ _______________________ ________ _________________ _____ ________ _______________________ ________ _________________ _____ ________ _______________________ ________ _________________ _____ ________ _______________________ ________ _________________ _____ ________ _______________________ ________ _________________ _____ ________ _______________________ ________ _________________ _____ ________ _______________________ ________ _________________ _____ ________ _______________________ ________ _________________ _____ ________ _______________________ ________ _________________ _____ ________ _______________________ ________ _________________ VISA, MasterCard, Discover or Sub Total _________________ The American Express Card C/C Name ______________________ 5.25% OK Sales Tax _________________ C/C # _________________________ (Oklahoma residents only) Card exp date _________________ S&H (leave blank) _________________ Signature _____________________ TOTAL (blank) _________________