24 Jason Way, West Bridgewater, MA 02379 - USA
TEL: 508 577-7635.. FAX: 775 459-4495

Supply Order Form
$100.00 minimum on all orders.

Billing Address

New Customer Address Correction

Company Name:

Buyer (Contact):


City: State: Zip Code:

Phone: Fax: E-mail Address:

Shipping Address

Fill in only if different than Billing Address
Company Name:

Shipping Address:

City: State: Zip Code:
*Note: UPS will not ship to a PO Box

Payment Method

Please ship C.O.D. (Check, Money Order or Certified Check)

PayPal ( Invoice payment link will be sent by e-mail when order is shipped )

CREDIT CARD (Secure Payment Form)

Visa MasterCard Discovery

Account Number (please include all digits):

Exact name as it appears on card:

Expiration date (mm/yy):

Items Ordered

Please remember to specify item #, quantity (color if applicable) and total.

Shipping plus $5.00 handling charges will be added to your invoice.


Knife & Tool Handle Washers

Leather Washers

Water Meter Gaskets

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