Dixie Ltg. & Electrical Supply                       phone; 504 735-0946 
 14383 Hwy 21                                         fax : 800 259-0969
 Bogalusa La  70427                          

 freight allowed on orders 400.00 or more (our choice)
 terms; net 30 days for open accounts
  or visa/master card, #________________________________exp.date_________
  prices; subject to change; you will be notified if changed.
          these prices are for internet orders only!

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  FAX ORDER TO: 800 259-0969     or 504 735-0946


  bill/ship to;__________________________________________                                
      
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  special shipping info.________________________________________________

  purchase order #________________________________  DATE________________

  ordered by     ________________________________
  
  phone #   ______________________________________

  fax       ______________________________________

  e-mail    ______________________________________

  FOR SPECIAL ITEMS PLEASE SEND PART # /DESCRIPTION; WE WILL CHECK AVAIL
  AND PRICE ASAP.