The Free Energy Store Purchase Order
Where Free Energy Rules

300 W. Utah Ave. Suite 101

Las Vegas, Nevada 89102-2756

Phone: 702-320-0770  Fax: 702-320-0270

P.O. #

DATE: 


Order From:

             .

            

 

Ship To:  (Must be a street address )

Comments or Special Instructions:


SALESPERSON

P.O. NUMBER

SHIP DATE

SHIP VIA

F.O.B. POINT

TERMS

           

QUANTITY

DESCRIPTION

UNIT PRICE

AMOUNT

Ea

 

 

 

Ea

 

   

Ea

 

   

Ea

 

 

 
 

Pay  by check, or credit card. Or US Postal money order.

   
 

Credit card type__________  Exp Date:____Mo.____Yr.

   
 

Card Number_______________________

   
 

Name on card_______________________

   
 

   
       

Note: Freight paid to your door. Within the Continental 48 States. Shipped via UPS

SUBTOTAL

 
   

Nevada only    Tax 7.25

 

TOTAL DUE

 

The Free Energy Store.

If you have any questions concerning this order, contact Russ, 702-320-0270, Russ@TheFreeEnergyStore.com

THANK YOU FOR YOUR BUSINESS!