The P. B. Helms Company Order Form
NAME______________________________________________________________________
ADDRESS___________________________________________________________________
CITY_______________________________________________________________________
STATE_____________________ZIP_____________________________
TELEPHONE____________________________EMAIL_________________________________________
Please check one.
Pay by
Check________ Money Order_______ Credit or Debit Card_________
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ITEM NO.
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DESCRIPTION
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QTY
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PRICE EACH
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TOTAL
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TOTAL______________________
HANDLING CHARGE: $5.00
TOTAL:__________________________________
CARD #________________________________________________________________
EXP______________
PRINT NAME____________________________________________
Please include the billing address for your card if different from your ship-to address.
MAIL TO:
The P. B. Helms Company
2819 WORLEY DRIVE
Maiden, NC 28650
