Mercury Supply Company Sutler

Printable Order Form

This form can not be sent by email but is given so you can PRINT this form and MAIL it to -

Mercury Supply Company Sutler
101 Lee Street
Livingston, TX 77351
Call
(936) 327-3707
or (936) 327-1574

NO RETURNS will be allowed without prior approval and no credit is given for any and all shipping costs.  Please call for return authorization.

Name: ____________________________________________________

Shipping address: Is this address  ___________ Residential  OR   _____________ Business (Commercial)

Street Address: _____________________________________________

City: ________________________________________

State/Province: ________________________________

Country: ______________

Zip Code/Postal Code: __________________________________

E-mail address: ________________________________________


Credit or Debit Card Billing Information

Type of credit or debit card:

_________ Visa
_________ MasterCard

Card number: _________________________________________

Expiration date: ____________

Day-time phone number: _________________________________
(In Case we need to contact you regarding your order)

 

Cardholder Billing Information (To be completed if different than shipping address.)

Cardholder name: _______________________________________

Credit card billing address: _________________________________

City: _____________________________

State/Province: _____________________

Country: ____________

Zip Code/Postal Code: _______________

Items To Be Shipped

Qty       Catalog #                Product Description             Size, Color, Etc.          Price Each

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Processing/Shipping/Handling Cost For U.S. Addresses. (Orders shipped US Priority Mail.)
 
  • Small Envelope = $3.50

  • Min. Charge = $7.50

  • up to $50.00 = $15.00

  • up to $160.00 = $20.00

  • up to $230.00 = $26.00

  • up to $350.00 = $32.00

  • Over $350.00 = Actual shipping costs

Shipping cost: ___________________

Sales Tax: 8.25% for Texas residents only.

Tax (if applicable): __________________

Order Total: _______________________