Thomas Distributing Product Order Form
Please use this Form if you are unable to use the Shopping Cart program
(Please fill in the details and click on the "Submit Order" button)
Use additional forms if needed.
Your Order Details
Qty Item/Order # Description Price Ea Total
Enter the Sub-Total of all items ordered Sub- Total
Illinois Sales ( Add only if you live in the state of Illinois) Sales Tax 6.25%
Shipping Charges If Known    ( Shipping Chart for UPS Standard Ground , Parcel Post, or Best Way Only ) Shipping
  Order Total
Shipping and Contact Information
Name *Required
 Member Number ( If available)
Company *Required if Applicable
 Tax Exempt Resale Number ( If available)
Address (Ship To Address)*Required
 Purchase Order number  ( For Reference Only)
City*Required
  
State/Province*Required
 ZIP Code/Postal Code *Req.
 Please include your Email Address so we may contact you if we have a problem with your order.
Telephone*Required
- 		Fax
- 		Email Address*Required
Please Note: We do ship COD, but all first time COD orders must be called in via our Toll-Free Order Line. We do not accept COD orders placed from our Web-Site unless you are a current active customer .
Payment Details *Required
VisaMasterCard Discover		 Card Account Number*Required
---     
Expiration Date*Required
Month Year...
Name as Printed on the Credit Card (Must be exact)*Required
 Credit Card Company or Bank Name*Required
Is the ship to address above the same as the billing address for Credit Card. Yes No ( If No please fill out the Billing Address Below.)
Credit Card Billing Address (Required only if Ship to address is different)
Address:

City:

State:                                                                     Zip:
 

Please Read

If the fields marked required are not completed, your order will be delayed until all information is supplied, or it will be canceled. All required fields are needed for your and our protection, in order  to prevent someone other than you from using your Credit Card for unauthorized purchases. In other words only the authorized user of this card would know the answers to these questions and we verify billing your address with your Credit Card provider.  All suspected credit card fraud will be reported to the proper authorities.

Thank You !

Shipping Method (Choose 1)
Ship Via :UPS (Standard Ground)  Parcel Post (US Mail Parcel Post) BEST WAY ( We chose best Way )
Please note that UPS will not deliver to PO box address.  UPS shipments require a street address for delivery ! We will notify you if your shipping choice is not available to your destination. After pressing the submit button, confirmation of your order will follow. Thank you.
( Check your order and Click here when your order input has been completed )
Or you may Print this order Form and Send to us via US Mail or Fax-It to us at 1-217-466-4212
( Click here to clear all of the fields on this form.)