To order online, please fill out the following form and submit your
order via our secure server.
To order by fax, print out this form, include credit card number and
fax to 973-639-9499.
To order by mail, print out this form and send it in along with your
payment made payable to:

JC Pacific Trading Co.
45-53 E. Bigelow Street
Newark, NJ 07114

CUSTOMER INFO

Purchasing Manager:

Company Name

Address:

City:

State:

Zip:

Tel:

Fax:

Email:

Purchase Order Number:

Card Number:

Card Expiration Date:

Card Holder's Name:

Billing Address:

City:

State:

Zip:

Tel:

Purchase Order

Extension

45-53 E. Bigelow Street, Newark, NJ 07114 Tel: 973-639-9400 Fax: 973-639-9499 E-mail: sales@jcpacific.com
All Rights Reserved © 2005 JC Pacific Trading Co.