Order Form

Download a printable order form here

Customer Information
 Required fields are marked with *		 Shipping Information
 If different from Customer Information
Company *
Contact Person *
Address *
Address 2
City *
State *
Country *
Zip Code *
Phone Number *
Fax Number
Email Address *
Company
Attn:
Address
Address 2
City
State
Country
Zip Code
Phone Number

Order Information
 Purchase Order

Qty. Stock Number Item Description Unit Price Total Price
To order more items, submit this order, then hit your browser back button.

Memo:

PRICE INFORMATION
Pricing excludes 10% Federal Excise Tax
and applicable sales taxes.

DELIVERY
 Freight - FOB
Lakeland Incorporated
Isle, Minnesota

LAKELAND TERMS
 Open Account (Net 30 Days)
for established credit accounts.
Cash with Order or C.O.D.
VISA/MASTERCARD