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Diefenbacher Tools
11611 W Prentice Pl

Littlton Co 80127

Print Me!

720-502-6687

E-mail: ron@diefenbacher.com

Print Name:
Address:
City:                                                                      State:                         Zip:
Daytime phone number:
E-mail address (for shipping and tracking information):

   
Stock # Quantity Description Size Price Ea. Total Cost
           
           
           
           
           
           
           
Sub Total  
CO Sales Tax 5%  
Shipping  
Grand Total  
Standard Shipping (UPS Ground)  Call 1-800-326-5316 for expedited shipping options.
Shipping
and Packing to 48 contiguous states:

Merchandise Total:         Add:
$0--------$20                $7.50
$20.01----$40               $9.00
$40.01----$60               $10.00
$60.01----$99               $10.50
$100 or over                 $12.00

Payment Options:                  

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Expiration Date  
Signature  

               
O  Check or Money Order
O  Visa
O  MasterCard