On The Move, Inc.
28825 IH 10 West, Boerne, TX 78006
1 800 645 9949  -  830 755 2474  -  830 755 2484 fax

SUPPLY ORDER FORM

DATE ORDERED: (mm/dd/yy)
TRUCK RENTAL AGREEMENTS with SAFETY QUALIFICATION RECORD
(125 rental agreements and 125 safety qualification records per package)		 @ $55 X = $
FURNITURE PADS
(80 lbs per dozen)(Package of 12)		 @ $150 X = $
FURNITURE PADS
(60 lbs per dozen)(Package of 12)		 @ $125 X = $
HAND TRUCK (1) @ $150 X = $
HUBCAP SIMULATORS
(each) - (for FORD E-350)		 @ $75 X = $
ACTION! JACKETS
(Package of 50)		 @ $15 X = $
INCOME/EXPENSE LEDGER
(1 book)		 @ $7 X = $
MOISTURE AWAY
(12 - 32 oz. bottles)		 @ $78 X = $
PEST AWAY
(12 - 6 oz. bottles)		 @ $66 X = $
METAL SAVE
(12 - 10 oz. bottles)		 @ $52 X = $
WOOD SAVE
(12 - 16 oz. bottles)		 @ $66 X = $
DIE CAST MINI TRUCK @ $39 X = $

PLEASE CHOOSE SHIPPING: OVERNIGHT 2-DAY AIR 3-DAY GROUND
Total cost will be billed upon receipt of order. Billing will also include shipping and handling.
Total to be billed to customer
(This price does not include shipping and handling) 		= $
Account # Last 5 digits of the VIN #
(One of these must be provided for verification purposes.)
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