ON LINE ORDER FORM

NOTE: * represents all fields listed below which are required.

 Billing Information:
(If you do not have a current account with Cantesco please also download and forward a completed New Account Application from the DOCUMENTS section of this web page)
       
ACCOUNT NO.:
* STREET ADDRESS:
*_ORDER_CONTACT:
* CITY:
* FIRM NAME:
* STATE/PROVINCE:
* PHONE (+ Ext):
* ZIP/POSTAL CODE:
* FAX:
* EMAIL:
* METHOD OF PATMENT::
    
 

(This is not a secure site DO NOT PROVIDE A CREDIT CARD NUMBER ON THIS FORM. For secure on-line ordering use the Cantesco STORE.)
 Shipping Information:           Same as above
       
SHIP TO NAME:
SHIP TO STREET ADDRESS:
SHIP TO CITY:
SHIP TO STATE/PROVINCE:
SHIP TO ZIP/POSTAL CODE:
ATTENTION:
   
* PURCHASE ORDER NO:
REQUISITION NO:
REQUIRED DELIVERY DATE:
    
CERTIFICATES:
    
       
* NAME OF CARRIER:
ACCOUNT NO:
* TERMS OF SHIPMENT:
    
* DO YOU WANT THE DECLARED VALUE ON YOUR SHIPMENTS:
       
 Item Description & Quantity Required: (Please use ITEM numbers from the CATALOGS PAGE)
 1: 
 2: 
 3: 
 4: 
 5: 
       
 ADDITIONAL SHIPPING INSTRUCTIONS:
 (Enter additional shipping instructions in the box above i.e. Deliver to Receiving Door #1.)
 
       
 ADDITIONAL ORDER INFORMATION:
 (Enter additional order information in the box above.)
 
       

Ready to place your order? click "SUBMIT". An order confirmation will be sent within 1 business day.