Order Form

Print this page and fax to: 1-866-285-9203 or

Mail to: B & G Specialty P.O. Box 192 East Schodack NY 12063


	BOLD = Required

SHIP TO:
Name:
Email Address:
Phone:
Address:
City:
State:
Zip Code:
Billing Address(if different):
Credit Card (Circle One): MasterCard Visa
Credit Card Number:
Expiration Date:
Item Quantity & Number	Price	Total









*NYS Residents Add 8.25% Sales Tax:
**Grand Total


	*Sales Tax is applicable to shipping charges

	**Standard UPS Ground shipping charge will be added.