Pressure Tank Order Form
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
To order by Fax or Mail print out the completed form and send to us with check or payment info.
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