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Wiko Distributors
FAX Express Order Form

Date_________________________

Account #_____________________

Company Name_____________________________________________________

City_______________________________________State___________Zip_______

Contact's Name______________________________________P.O. #___________

Ship To:____________________________________________________________

Street_____________________________________________________________

City______________________________________State___________Zip_______


SHIP
    _UPS Ground        _UPS 2nd Day        _UPS Next Day         _FedEx Express Saver

Quantity
Item
Price
     
     
     
     
     
     
     
     
     
     
     


See WLP-96-D and NLP-97 for terms and conditions.


To order by fax, print out this form and fax to 1 (800)-241-9928
Or mail to: Attn: Web Order
EiKO Ltd
7650 W. 85th Street, Ste. C
Tinley Park, IL 60477