Discount Ramps.Com LLC Order Form

Product Part #_______________________
Description____________________________________
Price of item:$______________________
Price of Shipping$___________________
Total$____________________________
Tax charged only to Wisconsin Customers- 5.6%
Ship To:
Name______________________________________
Business________________________________________
Address________________________________________________________________________________________________

City_______________________________________

Telephone Number____________________________

State___________Zip Code_________________________

E-mail Address___________________________________
 
Bill To: (if different than ship to)
Name______________________________________
Business_____________________________________
Address________________________________________________________________________________________________

City_______________________________________

Telephone Number____________________________

State___________Zip Code_________________________

E-mail Address_____________________

Circle form of payment
Certified/Cashiers Check            Money Order          Personal Check        Net 30 (pre-approved only)

Federal Tax ID # (Net 30 only) _______________________________________________

Circle credit card to be used
Visa        MasterCard        American Express        Discover        Government Impact 
Card Number __________________________________ 
Expiration Date__________

Comments or special requests:_____________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

Print this form, fill out and send with payment to:
Discount Ramps.Com LLC
760 S. Indiana Ave.
West Bend, WI  53095
or fax to (262)-306-8035