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Please print this out and mail the fully completed form to:
Tom Dixon
Controline Sales L.L.C.
315 Santa Anita Ave
Woodstock, Ga. 30189
USA

Or Fax the completed from to (770) 592-3279

*Make checks payable to Controline Sales, LLC*

Name:____________________________________
Date Ordered______________
Address:__________________________________   City:_____________________  State:_____________
Zip/Postal Code____________
Phone Number______________

#

DESCRIPTION

PRICE EACH

TOTAL PRICE

       
       
       
       
       
       
       
       
       
       
  Merchandise Total:        __________________
  (GA res. add 6% Tax:)   __________________
  Shipping Charge:            __________________
*Make checks payable to Controline Sales, LLC* TOTAL ENCLOSED     __________________

Visa or Mastercard: Give card number, expiration date and v-code on back of card. Write clearly!
Many postal zip codes have recently changed. Be sure you are listing the most current.

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