PRINTABLE PURCHASE ORDER FORM

Please include this information with your order

 TO:    
 SALT OF THE EARTH WEIGHTED GEAR - 1031 17th Street, - Henderson, NE   68371

COMPANY:______________________________                        PURCHASE ORDER NUMBER______________

                                                                                                                                                 DATE__________

 
 BILL TO:                                                                               SHIP TO:












NOTES:
                                                                                                                                              
Contact Person:                                                                        PAYMENT:
Name_______________________________                        
 I HERBY CERTIFY THAT THERE IS AN UN OBLIGATED BALANCE IN THIS
                                                                                                                                                                                APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER

Number______________________________



                                                                                                                                                                                ________________________________________________________________________
                                                                                                                                                                                               SIGNATURE