Mobile Home Depot Inc.
Fax # 248-889-4556
     FAX
Order Form
    
(Please print clearly)
Customer Name:
 Date:
 P.O. Number:
Address:
 Ship. Address:      Buisness     or    Residential
(circle)
City, State, Zip:
 Billing address different than shipping address:
(circle)                      Yes         or          No
Phone:
 Fax:
ITEM
 PART #
 DESCRIPTION
 QTY
 PRICE
 TOTAL
1
          
2
          
3
          
4
          
5
          
6
          
7
          
8
          
9
          
10
          
11
          
12
          
13
          
14
          

         
Shipping Quote desired (circle):                    Yes                             No
 Shipping=

TOTAL =
Signature:
MHD Inter-Office Use Only
Contacted:
Shipping Quote:
 Drop Ship:
Ship Via:
 Payment:
  
Confirmation/Tracking #
CC.
 Exp.
 Pin.
Processed By:
Total
(w/Shipping):