Make payable to:
M / E Iron Works
Rt. 1, Box 35 N-2
4501 N. Council Road
Crescent, OK  73028		 Contact Us:
Office #:  (405) 969-3267
E-mail:  eva@meironworks.com

Date: ________________

BILL TO: SHIP TO:    (if different from billing address)
Name: Name:
Address: Address:
City/State/Zip: City/State/Zip:
Phone #: Phone #:
Email:  

Item Number

Item Description

Qty

Price

Total

         
         
         
         
         

Sub-Total: ____________
Sales Tax (Oklahoma residents add 8.5%): ____________
Shipping: ____________
GRAND TOTAL: ____________

Credit Card Information (choose one)
Visa       Mastercard       
Credit Card #: Expiration date:


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