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Number: ___________________


Date: _____________ (month & day), ______ (year)



To: ____________________________



We hereby confirm your purchase order as the following:


Merchandise Ordered: _________________________________________


Terms of Shipment: ___________________________________________


Delivery Date: _______________________________________________


Delivery Point: _______________________________________________


Terms of Payment: ____________________________________________


All prices herein quoted are exclusive of sales, use, and other excise taxes.  All such taxes, and any other taxes measured, in whole or part, by gross receipts applicable to this transaction are to be borne by the purchaser.  All export, import and other duties, tariffs and customs shall be paid by the purchaser.  If exemption is claimed by the purchaser from any of the foregoing, the purchaser shall furnish satisfactory proof of such exemption.


By: _____________________________


Receipt of the above is acknowledged this ______ day of _______ (month), _____ (year).






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