Needa Manufacturing 4654 Logtown Rd.Lena, WI 54139 (orders-only address) 800-440-8671 / Fax: 920-834-5257 OPEN: Mon-Fri 8 am-5 pm Central Time Print This Order Form... ...and write in your selections from our Product Listings. Fill in the quantities and purchasing information. See the shipping chart below to calculate your shipping costs. Then, just call in, mail in, or fax in your order!

Charge to: Ship to: Street Address: Street Address**: City: City: State___     Zip __ __ __ __ __ - __ __ __ __ State___     Zip __ __ __ __ __ - __ __ __ __ Phone: Fax: e-mail __________________________________________________________________________________ SPECIFY BILLING PREFERENCE: ___Check #_________________ ___P.O. Number_________________ ___Credit Card Order ___Bill an Open Acct (Subject to approval. Include 3 credit references) Credit Terms:  30 Days We will furnish quotations to schools. institutions,and groups for supplies or any given item in large amounts. All our customers are entitled to current prices and discounts. IF BY CREDIT CARD, SPECIFY:       ___ VISA  ___MasterCard Acct No:  __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiration Date______________ Print Cardholder's Name ________________________ Cardholder's Address _______________________________ ____________________________________________ CALCULATE YOUR SHIPPING Add the appropriate amount to your order. Up to $15.00 $5.90 $15.01 to $25.00 $7.25 $$25.01 to $45.00 $10.00 $45.01 to $65.00 $13.50 $65.01 to $90.00 $16.00 $90.01 to $125.00 $21.00 $125.01 to $200.00 $26.00 $200.01 & over 20% ** UPS and RPS will not deliver without a street address. Qty Product # Description Price Each Amount Subtotal: $ Sales Tax (WI residents): $ Shipping (see chart): $ Total Price: $ Signature_______________________________________

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Needa Mfg. / 4654 Logtown Rd / Lena, WI / 54139 / 800-440-8671 / Fax: 920-834-5257