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
(25 Sheets per book, Minimum Order 5 Books)		 @ $7 X = $
SAFETY QUALIFICATION RECORD
(125 Sheets per package) 		@ $20 X = $
ACTION! JACKETS
(Package of 50) 		@ $15 X = $
FURNITURE PADS
(60 lbs per dozen)(Package of 12)		 @ $125 X = $
FURNITURE PADS
(80 lbs per dozen)(Package of 12)		 @ $150 X = $
INCOME/EXPENSE LEDGER
(1 book)		 @ $7 X = $
HAND TRUCK (1) @ $150 X = $
HUBCAP SIMULATORS
(each) - (for FORD E-350)		 @ $75 X = $
MOISTURE AWAY
(12 - 32 oz. bottles)		 @ $78 X = $
PEST AWAY
(12 - 16 oz. bottles)		 @ $66 X = $
METAL SAVE
(12 - 10 oz. bottles)		 @ $52 X = $
WOOD SAVE
(12 - 16 oz. bottles)		 @ $66 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.)
SHIPPING ADDRESS:
COMPANY NAME:
ADDRESS:
CITY: STATE: ZIP:
ATTN: PHONE:
EMAIL:
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