Order Form

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Mail In Order Form

AGL Distributors

Bill To:

Name:____________________________

Address:__________________________

City:___________________ State:______

Zip Code:__________

Daytime Phone:(_____)___________________
(used only if we have questions regarding your order)

Ship To:

Name:____________________________

Address:__________________________

City:___________________ State:______

Zip Code:__________

Item Number	Description	Quantity	Price Each	Total

Sub Total

SC Residents add 5% tax

Shipping within US only

$_________

Total

Shipments within the Continental US only,
Up to 2 lbs..........add $4.95
3-4 lbs.................add $5.95
5-6 lbs.................add $6.95
7-8 lbs.................add $7.95
9-10 lbs...............add $9.95
Over 10 lbs we will calculate

Make Checks or Money Orders payable to:
AGL Distributors

Mail to:

P. O. Box 674
Conway, SC 29528

Thank you for your order!
Please allow 2-6 weeks for delivery.

Sub Total
SC Residents add 5% tax
Shipping within US only	$_________
Total