Superior Pad Outfitters
Toll Free: 888-855-7237  |  Fax: 541-855-2385
Complete Order Form and mail to address below.  PLEASE PRINT CLEARLY.

BILL TO:	SHIP TO:
ADDRESS:	ADDRESS:
PHONE #:	PHONE #:
FAX #:	FAX #:
Credit Card #	Expiration Date:
Name on Credit Card:	Street Number & Zip Code where credit card statement is received:
Check/Cashier's Check #	Purchase Order #:

QTY	ITEM NO.	DESCRIPTION	PRICE	TOTAL
			Subtotal
		Call or email for shipping charge.	Shipping
			Payment Enclosed