1-800-366-3907 C.F. BENDER COMPANY, INC. - PRINT 'N FAX ORDER FORM INSTRUCTIONS: - 1. Print from browser - 2. Fill it in - 3. FAX it to (913) 371-1572

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BILL TO:_____________________________  _____________________________________   _____________________________________  _____________________________________  Contact:_____________________________  Phone:(_____)________________________  Fax:     (_____)________________________

SHIP TO:__________________________  __________________________________   __________________________________  __________________________________  Contact:__________________________   Phone:(_____)_____________________  Fax:     (_____)_____________________

CFB Acct. Number:_____________________________	Credit Card No:_______________________________
Signature:____________________________	Expiration Date:______________________________
	Card Holder Name:_____________________________

Purchase Order No:	Ship Via:
Direct Inquiries To:	Date Required:

PART NUMBER	QUANTITY	DESCRIPTION	UNIT PRICE

SPECIAL INSTRUCTIONS:

Fax (913)-371-1572

www.cfbender.com