Clark Office Products, Inc.
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Order Form

This form can be e-mailed by submitting it once completed. If you'd prefer, you can fill it out online, print it using your computer's print function (File - Print) and fax it to us. In Mountain Home, fax to (870) 425-0757; in Harrison, fax to (870) 741-9812.

* - Required field

Ordered by / bill to:
* Business Name:
* Contact Person:
* Address:
* City:
* State: * Zip:
* E-mail:
* Phone:
Indicate best time to call:
Time zone (i.e., Eastern):
Fax:

Deliver to:
* Business Name:
* Person Receiving Order:
* Address:
* City:
* State: * Zip:
* E-mail:
* Phone:

If you are not using a catalog, please describe what you need in the appropriate areas below. If you need to order more items than space is available for, please submit multiple forms.

Item 1
Page # (if using catalog):
Item #:
Description of item:

Color:
Unit:
Price:
Qty:
Total cost:

Item 2
Page # (if using catalog):
Item #:
Description of item:

Color:
Unit:
Price:
Qty:
Total cost:

Item 3
Page # (if using catalog):
Item #:
Description of item:

Color:
Unit:
Price:
Qty:
Total cost:

Item 4
Page # (if using catalog):
Item #:
Description of item:

Color:
Unit:
Price:
Qty:
Total cost:

Item 5
Page # (if using catalog):
Item #:
Description of item:

Color:
Unit:
Price:
Qty:
Total cost:

Merchandise total:
Applicable sales tax (AR residents add 7.125%):
Total:

Payment type:
Call for bid
COD
Open account

By checking this box, I authorize Clark Office Products to complete my order: Initials:

Want to pay by credit card?
We do not currently offer secure online ordering. We will be happy to call you to get your credit card information, at your convenience.

Best time to call:
Best day to call:
Number at which you wish us to call:




 


BJM 4/3/08
© 2008 COPR 326