Mr. G's Enterprises - Order Form 5613 Elliott Reeder Rd. - Ft. Worth, Texas 76117-6013

Billing Address	Shipping Address
To:	To:

Phone #

Fax #

Email:

Note: Please give a street address. Truck lines and UPS will not deliver to a P.O. Box.

Your Order #	Date Shipped	Shipped Via	F.O.B. Point	Terms

Part Number	Qty	Shipped	B/O	Description	Unit Price		Total

Credit Card Information	Sub Total
Card #	Shipping 11%  (Minimum $8.00)
Expiration Date:  Month:        Year:	Texas 8.25% Sales Tax
Billing Address:	C.O.D. $ 9.50
Circle One:     Visa   M/C   A/E   Disc.	Total Amount
Customer Signature:	January 2006 Prices subject to change without notice.

Phone: (817) 831-3501 -- (817) 838-3131
E-Mail: mrgs@mrgusa.com -- Fax: (817) 831-0638