Shen Enterprises - Wholsale Order Form

3510 Old Santa Rita Rd. Suite D, Pleasanton, CA, 94588
Tel: (925)847-8889 Fax: (925)847-4180

Bill To:
Name:____________________________
Address:__________________________
_________________________________
Telephone:_________________________
 Ship To:
Name:____________________________
Address:__________________________
_________________________________
Telephone:_________________________

Item Number Product Name (Optional) Quantity Unit Price Total $ Amount

































































Subtotal:__________
C.O.D Charge $4.00 If any:__________
UPS Ground shipping charge:__________
Total:__________
Method of Payment:
Cash - (Money Order / Cashier's Check)
Credit - (Visa / MasterCard / Amex)
Card No. __________________________________Exp. Date_________

If this is your first order, please complete below:
Professional Title:_______________________________________________________
Professional License No._____________________ Or Resale License No. __________
Prefered method of contact________________________________________________