Order Form - Jack L. Marcus Company Institutional Sales Catalog

Order Form
C-4006
Please print and include complete street address.
Please Ship To:
Name:
FIRST
Institution Name:
LAST
ID#
Housing Unit:
Street Address:
City:
State:
Item Number
Size
Color
Inseam
Length 1st Choice 2nd Choice
Zip:
Description
Quantity
Price Each
Total Price
Merchandise
Total
Order Placed By:
Name:
Free Shipping For
Orders Over $100
Street Address:
City:
Institution (If Applicable):
ID# (If Applicable)
Method of Payment:
State:
Money Order
Zip:
Note: All alterations performed
on electronic devices will void
the manufacturer's warranties
and are irreversible.
Institution Check
MICHIGAN & WISCONSIN
RESIDENTS ONLY!
Offer good through SEPTEMBER 30, 2016.
Payment must accompany order.
Mail order to:
Jack L. Marcus Inc.
5300 W. Fond du Lac Ave.
Milwaukee, WI 53216-1348
Phone: 1-800-236-2611 • 1-414-438-4999
Fax 1-800-643-9992 • Fax 1-414-438-4978
Phone Hours: 8:30AM - 5:00PM Central Time Monday-Friday
Remove
Antenna
Check box if you want
us to remove antenna.
$5.00
Free
Subtotal
Sorry, we do not accept personal checks.
Credit Card - MC / Visa / Discover
All credit card orders must be phoned in, $400 Maximum Limit.
Shipping and
Handling
Please Add Applicable
Sales Tax Here
MI Residents Add 6%.
WI Residents Add 5%.
Total Amount
Due
If you would like to receive our catalog please call 1-800-236-2611 or 1-414-438-4999,
8:30AM-5:00PM Central Time, Monday-Friday.
We have no minimum order. This catalog can be used by anyone.
Please allow 10 business days after receipt of your order for delivery.
Returns: If an item is found to be defective upon receipt and returned to us within 60 days, it
shall be repaired or replaced at no charge. Food products cannot be returned.
© 2016 Jack L. Marcus, Inc.
G.S.A. #: 53216 - JACK - 001
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