NEW YORK BARBELL OF ELMIRA CORP.
PO Box 3473, Elmira NY 14905-3473
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