Pressure Tank Order Form
SECURE ORDER FORM
1600 E. Washington Blvd., Los Angeles, CA 90021
P.O. Box 30507, Los Angeles, CA 90030-0507
800-421-9395, (213) 747-7514, Fax (213) 747-7724

info@hansontank.com
roy e. hanson jr. mfg. logoTANKS IN STOCK AIR | WATER

FAX OR MAIL

ONLINE

To order by Fax or Mail print out the completed form and send to us with check or payment info To order online by Credit Card, click "Send" button at the base of form and print a copy for your records
BILL TO:
*Company
*Contact
*Address
*City
*State *Zip
*Phone Fax
E-mail
SHIP TO: (if different from billing address)
Company
Contact
Address
City
State Zip
Phone Fax
E-mail
Qty Part# Description Each Total
$
Notes:
PO# Mark shipment:
*SALES TAX is due on shipments to Calif destinations unless for resale.
If so, enter Ca Resale #
PAYMENT METHOD: Credit Card Fax/Mail only: Check or Money Order Wire Transfer
Note: To apply for Net 30 day terms, please attach credit references (Fax / Mail only)
*Card No *Expiration Mo/Yr /
*Billing Zip *Billing Phone#
Signature (Fax/Mail)



Total
Sales Tax *see note
Sub Total
Shipping Pre-Pay and Add**
Total

** Please call for shipping quote if required