Order Form
Submit order to:
Gail M. Van Tatenhove, PA
8322 Tangelo Tree Drive
Orlando, FL 32836-5437
Bill To:
Ship To:
Name
:
Address
:
Telephone
:
Fax
:
Email
:
Name
:
Address
:
Telephone
:
Fax
:
Email
:
Item Number
Product Name
Quantity
Unit Price
Total Price
$
$
$
$
$
$
$
$
$
$
Subtotal:
$
International
Orders
(please add 10%)
$
Total Amount Due:
$
Mail with check or money order to:
Gail M. Van Tatenhove, PA
8322 Tangelo Tree Drive
Orlando, FL 32836-5437
Fax Purchase Orders to:
(407) 876-2120
PO #
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