Mephisto Tool
Order Form

To use this form, make a print and fill in the information. It may be sent by Fax or Mail. If you prefer, scan the sheet and send it by E-mail attachment. Also, you may write out your own Paper or E-mail
message, with the requested information. Or just pick up the phone and talk to us.

Fax: 518-828-2711
Phone: 518-828-1563
E-mail: CustomerService@MephistoTool.com		 U.S. Mail:
Mephisto Tool Co., Inc.
PO Box 16
Hudson, NY 12534-0016


If applicable, please include your Tax Exempt Resale Certificate with this page. It only needs to be sent once.
E-mail Address:
 ___________________________________________________________
Bill to Name:
 ___________________________________________________________
Bill to Address:
 ___________________________________________________________
___________________________________________________________
Ship to Name:
 ___________________________________________________________
Ship to Address:
 ___________________________________________________________
___________________________________________________________
Date of Order:
 ___________________________________________________________
Order Number:
 ___________________________________________________________
Line
Quantity
Part No.
Price Ea.
Discount
Line Total
           
           
           
           
           
           
           
           
           
           
           
           
           
Order Total:
  
Applicable shipping charges and tax will be added.
Refer to the "Distributor Info" page for related details.
  
Signed:
 ___________________________________________________________
Title:
 ___________________________________________________________