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:
Residence   Business
Street Address:Street Address**:
City:City:
State                    ZipState                    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

Custom quotes available for large orders.  Call for details
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 & over20%


** UPS and RPS will not deliver without a street address.

All orders shipped UPS Ground unless customer requests other method.
QtyProduct #DescriptionPrice EachAmount













































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