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Quick Order Form (U.S. Customers)

This form can be used if you prefer to fax or mail in your order form. Enter your item number(s) in the space below, and the website will fill in the description and current price(s). Then, calculate the Shipping and Handling costs (and taxes if applicable) manually using the table(s) provided. Provide the remaining billing, shipping, and payment information needed to complete the order, and then fax or mail the form to PAR (see below for fax or mailing information). Caution — once you print and close the form, you will not be able to retrieve the item information. If you need to include more items, write them in the Additional Items section, and update the order subtotal.

Quick Order Form Items

Enter your item numbers below, and the Quick Order Form will generate the item description and the price.

Note: Item numbers consist of 4 digits plus a 2-letter suffix (e.g., 2237-TB).

Item #QuantityItem DescriptionPriceExt AmountRemove
Subtotal 1:

Click here to print this form, and then complete the rest by hand.

(Please see the bottom of this form for fax or mailing information.)

Additional Items

This area is for you to hand-enter additional items and prices after you have printed your Quick Order Form.

Item # Quantity Item Description Price Ext Amount
Subtotal 2:

Shipping and Handling Rates

Shipping Rates - United States

Subtotal 1


Subtotal 2 $

Sales Tax:

Florida and Wisconsin residents, add applicable sales tax. Michigan residents, add 6% sales tax.


Shipping & Handling:

(Enter rate from box at left.) U.S. Ground Service (required on all U.S. orders)

Note: $8 minimum S&H charge.


PLUS expedited U.S. service charge:

(Enter desired shipping method


and $ amount for expedited service from box at left.)


Promotional Code:

Enter Promotional Code from special mailing (if applicable) and calculate.


Order Total (USD)


Customer Information

□ New Customer | □ Address correction | □ Register for online ordering (e-mail provided below)

Bill To:

Customer no. ______________________________ Date ___________________

Company/Institution _______________________________________________

Name _____________________________________________________________

□ Dr. | □ Mr. | □ Ms. | □ Mrs.

Address ___________________________________________________________

□ Home | □ Office

City _________________________ State/Province _______________________

Zip/Postal code ________________ Country ____________________________

Phone (______)_____________________ Fax (______)_____________________

E-mail address*_____________________________________________________

Ship To: (if different)

□ Residence | □ Business

Name _____________________________________________________________

□ Dr. | □ Mr. | □ Ms. | □ Mrs.

Company/Institution _______________________________________________

Street Address ____________________________________________________ (No P.O. Boxes)

City _________________________ State/Province _______________________

Zip/Postal code ________________ Country ____________________________

Phone (______)_____________________ Fax (______)_____________________

E-mail address*_____________________________________________________

* Tracking information will be provided via e-mail for U.S.A., Canada, and expedited international orders.

Choose Your Payment Method

□ Charge:

     □ MasterCard® | □ American Express | □ Diner's Club International | □ Visa® | □ Discover

     Card # (do not include hyphens) |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

     Exp. date |___|___||___|___|     CVV (3- or 4-digit number found on your credit card) |___|___|___|___|

     Name on card (if different than Customer)_____________________________________________________

□ Check enclosed payable to PAR, Inc.

□ Purchase Order enclosed (For Customers from the U.S.A., Canada, Puerto Rico, and the U.S. Virgin Islands only)

□ I accept responsibility for all shipping, handling, duty, and VAT charges for this order.

Authorized signature (Required on all orders) _____________________________________________________

Thank you for your order!

Prices are subject to change without notice.
Please call (1.800.331.8378 • 1.813.449.4065) for current pricing. Florida, Michigan, and Wisconsin residents, please include applicable sales tax.

Order Form may be submitted via fax (1.800.727.9329 or 1.813.961.2196),
or mail (PAR, Inc., 16204 N. Florida Ave., Lutz, FL 33549-8119).

Orders placed Monday–Friday by 6 p.m. ET will ship the same day (except holidays).

All other orders will ship the next business day. You will be notified of any unexpected delay.