Pine Creek Industries Order Form  (Please Print)

Name: ____________________________________________________________

Physical Address (for FedEx):




Phone Number: _____________________________________________________

Part # Part Name Quantity Price Total Price
Sub Total  
Shipping (See Below)  
Sales Tax (Add 6% of Sub Total )  
Total Amount Enclosed  

Standard Shipping for the Continental USA:

Residential delivery may be charged $3.50 additional.

For orders $25.00 and less add $8.00 for shipping
For orders $25.01 to $50.00 add 30% of sub-total
For orders over $50.01 add 12% of sub-total
C.O.D. orders will be charged a COD service charge

Total Enclosed:

For the fastest service, send Money Orders, or Cashier's Checks.  We will accept personal checks, but they must clear our bank before we can ship.  (usually 10 days)