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| Date Required: | |
| Terms: | |
| FOB Point: | |
| Sidemark: | |
| Requisition No./For: | |
| Routing: | |
| Please send ___ copies of your invoice with your bill of lading. |
Flooring Products / Item Numbers 
Item # |
Quantity |
Stock Number/Description |
Unit Price |
Total Amount |
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10. |
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Subtotal |
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Sales Tax |
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Shipping |
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Total |
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Special Instructions |
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Authorized Signature |
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| IMPORTANT Our Order Number must appear on Invoices, packages and Correspondence. Acknowledge if unable to deliver by date required. |
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© 2005, RCC Flooring, LLC |
