NEW YORK BARBELL OF ELMIRA CORP.
160 Home Street, Elmira NY 14904
Tel:1-800-446-1833; 607-733-8038; Fax: 607-733-1010

ORDERED BY: SHIP TO ADDRESS:
Mr./Mrs.  
Address:  
   
Tel #:  
Credit Card # METHOD OF PAYMENT: CIRCLE ONE
Exp. Date:  AMEX - DISCOVER - MC - VISA - MONEY ORDER - CERTIFIED CHECK

QUANTITY

CODE NO.

DESCRIPTION

UNIT PRICE

TOTAL AMOUNT

         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
      SUB TOTAL  
      FREIGHT  
    Add appropriate local sales tax if you live in New York or New Jersey SALES TAX  
092002     GRAND TOTAL