North States Industries Fax and Mail

NORTH STATES INDUSTRIES, INC. Fax / Mail Order Form
(go to file and click print)

North States Industries accepts cashiers checks, personal checks and money orders, as well as Visa, MasterCard, American Express and Discover. We will bill your credit card only for what has actually been shipped.

SHIPPING AND HANDLING (based on shipments in the Continental United States): $2.50 for Orders Under $10.00, $5.00 for Orders $10.00 or more.

FOR A PURCHASE OF $5.00 OR MORE, A CHECK OR CREDIT CARD IS REQUIRED. THERE IS A $5.00 MINIMUM ORDER FOR CREDIT CARDS. Pricing in U.S. Currency.

1. Product Number    Qty Amt
2. Product Number     Qty Amt
3. Product Number     Qty Amt

Shipping/Handling
Total
Billing Information:

First Name: _________________________ Last Name: ______________________ Middle Init: ___

Street Address: _______________________________________ City: _______________________

State/Province: ________ Country: _______________ Zip/Postal: _________________

E-mail address: _____________________________ Day Phone: _______________________

Shipping Information: (If same as above, skip this section)

First Name: _________________________ Last Name: ______________________ Middle Init: ___

Street Address: _______________________________________ City: _______________________

State/Province: ________ Country: _______________ Zip/Postal: _________________

Credit Card Information:

Credit Card Type: Visa MasterCard (check one)

Credit Card Number: ___________________________________

Expiration Date: ______________ (mm/yy ie. March 7, 2010 = 03/10)

To order by mail or fax please print out the forms provided. If ordering by fax please send the filled out forms to 763-486-1763. If ordering by mail, please send forms and payment to:

NORTH STATES INDUSTRIES, INC., 1507 92nd Lane NE, Blaine, MN 55449