Mercury Supply Company Sutler

Printable Order Form

This form can not be sent by email but is given so you can PRINT this form and MAIL it to -

Mercury Supply Company Sutler
101 Lee Street
Livingston, TX 77351
Or Call (936) 327-3707
Or Fax to:  (936) 327-3791

NO RETURNS will be allowed without prior approval and no credit is given for any and all shipping costs.  Please call for return authorization.

Shipping Information

Name: ____________________________________________________

Shipping address: Is this address  ___________ Residential  OR   _____________ Business (Commercial)
(Please Note: UPS cannot ship orders to P.O. Boxes and we must
have actual physical address - rural routes with box number not valid - 911 address.)

Street Address: _____________________________________________

City: ________________________________________

State/Province: ________________________________

Country: ______________

Zip Code/Postal Code: __________________________________

E-mail address: ________________________________________


Credit Card Billing Information

Type of credit card:

_________ Visa
_________ MasterCard

Card number: _________________________________________

Expiration date: ____________

Day-time phone number: _________________________________
(In Case we need to contact you regarding your order)

 

Cardholder Billing Information (To be completed if different than shipping address.)

Cardholder name: _______________________________________

Credit card billing address: _________________________________

City: _____________________________

State/Province: _____________________

Country: ____________

Zip Code/Postal Code: _______________

Items To Be Shipped

Qty       Catalog #                Product Description             Size, Color, Etc.          Price Each

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____      ________       _________________________    ______________         __________

____      ________       _________________________    ______________         __________


Shipping Cost For U.S. Addresses. (Orders shipped UPS.)

  • up to $30.00 = $6.50
  • $30.01 to $40.00 = $7.50
  • $40.01 to $50.00 = $8.50
  • $50.01 to $60.00 = $9.50
  • $60.01 to $80.00 = $10.50
  • $80.01 to $120.00 = $12.50
  • $120.01 to $160.00 = $15.50

  • $160.01 or more = $18.50

Shipping cost: ___________________

Sales Tax: 8.25% for Texas residents only.

Tax (if applicable): __________________

Order Total: _______________________