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ORDER FORM

   
 
To order online, please fill out the following form and submit your
order via our secure server.
To order by fax, print out this form, include credit card number and
fax to 973-639-9499.
To order by mail, print out this form and send it in along with your
payment made payable to:
 
JC Pacific Trading Co.
45-53 E. Bigelow Street
Newark, NJ 07114
   
 
CUSTOMER INFO
 
 
Purchasing Manager:
Company Name
Address:
City:
State:
Zip:
Tel:
Fax:
Email:
Purchase Order Number:
   
 
PAYMENT INFO
  Card Type:
  Visa Master American Express Discover
 
Card Number:
Card Expiration Date:
Card Holder's Name:
Billing Address:

City:
State:
Zip:
Tel:
  Payment by Check (print form and send via mail)
   
 
Purchase Order
                     
 

Item #

Descriptions

Unit Price

Quantity

Packing

Extension
 
1
 
 
2
3
4
5
6
7
 
8
             
 
 
* Note: we ship by UPS Ground, by truck or best way. We can also ship freight collect. All shipping charges must be prepaid. If C.O.D. surcharge applies. Please call or email us for a quotation on your shipping requirement. JC Pacific Trading Co. does not own trucks or manage the shipping. The shipping schedule and prices are subject to change without notice.
             
 
 
 

For More Info or to Place an Order
Call Toll Free 1-877-JCWHEEL (1-877-529-4335)

 

45-53 E. Bigelow Street, Newark, NJ 07114 Tel: 973-639-9400 Fax: 973-639-9499 E-mail: sales@jcpacific.com
All Rights Reserved © 2005 JC Pacific Trading Co.