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TO PAY BY CHECK/MONEY ORDER by MAIL or FAX
ORDER PAGE
Date:________________
PLEASE PRINT
Your
Name:___________________________________________________
Ship to Address:
_______________________________________________
City, State, Zip
Code:____________________________________________
Telephone #
(for order processing):
email address:
Payment Method:
p
Check/M.O. p
Credit Card: _______________________________Type: _______
Expires:____________ Security Code:_________
Billing Address (if different from shipping
address):_______________________________________________________________________________________
| Ref # |
Item
Description |
Sale Price |
Quantity |
+ Shipping |
= Total for
Item |
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TOTAL FOR ORDER: |
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PLEASE MAKE CHECKS PAYABLE TO
HomePlace Group, Inc.
TO PLACE YOUR ORDER:
Please print this form and fax it to or mail it along with payment. Please
email
us if you have any questions. You can FAX your check Toll Free to
1-877-875-5022 along with this order form. Please mail check/money orders to
along with this form to:
HomePlaceParts.com
Wholesale To The Public Center
P.O. Box 7106
High Point, NC 27264
Should you have question, please call
1-800-823-4233.
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