BayTec Containers FAX: 866.204.6230 4761 Hwy 146 SHOP ONLINE: www.ebaytec.com Bacliff, Tx 77518 E-MAIL: sales@ebaytec.com ______________________________________________________________________________ FAX & MAIL ORDER FORM (PLEASE PRINT AND COMPLETE) SHIP TO: ____________________________________________________ [ ] Check box Name if you are ____________________________________________________ shipping Address to a gift ____________________________________________________ recipient City State Zip Code Phone: Day ( ) ____________ Evening ( ) ____________ BILL TO: ____________________________________________________ [ ] Check box Name if same as ____________________________________________________ shipping Address* address ____________________________________________________ City* State* Zip Code* *Must be same as printed on Phone: Day ( ) ____________ Evening ( ) ____________ credit card statement E-mail: ____________________________________________________ ITEM ID DESCRIPTION QTY. PRICE EA. TOTAL __________ _____________________________________ ____ _________ __________ __________ _____________________________________ ____ _________ __________ __________ _____________________________________ ____ _________ __________ __________ _____________________________________ ____ _________ __________ __________ _____________________________________ ____ _________ __________ Attach separate sheet for more items. Subtotal __________ SHIPPING: UPS Ground* __________ TOTAL __________ PAYMENT: [ ] Visa [ ] MasterCard [ ] Discover [ ] American Express [ ] PO PreApproved [ ] Check/Money Order Acct No: _____________________________________________ Exp. Date: ____/____ Signature _____________________________________________ (if using credit card) ______________________________________________________________________________ Please fax this form to 866.204.6230, or mail it to the address above. Please * Visit http://www.bayteccontainers.com/shin.html for ordering, shipping & payment info.