Order Information
Phone:  (330) 669-2297
Fax:   Print this form and fax it to (330) 669-2892
Mail:  Send this form to Flying Dutchman Inc., 6631 Egypt Road, Smithville, OH  44677

Terms & Conditions
All parts are FOB Flying Dutchman Inc., Smithville, OH 44677

Shipping Information
All items will be sent standard Ground UPS unless another carrier or method is requested.

Order Form

Product	Item	Description	Price	Qty.	Total
				Subtotal
				Tax
				Total

Shipping Address

Name
Address
City		State
Country		Zip
Email

Billing Address
  Check if same as shipping address

Name
Address
City		State
Country		Zip
Email