A.Y. McDonald - manufacturer of Waterworks Brass, Plumbing Valves, Pumps and Water Systems and High Pressure Gas Valves and Meter Bars

A.Y. McDonald Mfg. Co.

This form is for use by existing customers only.

Complete form and press SEND at bottom of page.

Date:	Nov 20, 2008
BILL TO (all fields are required):		SHIP TO (If different from bill to address):
Name:		Name:
Company:		Company:
Address:		Address:
Address2:		Address2:
City, State:		City, State:
Zip:		Zip:
E-Mail:
Phone Number:

Customer Purchase Order Number:
Quote Number 1 (If applicable):
Quote Number 2 (If applicable):
Ship Via:
Required Date:

Please provide any special instructions, comments or questions here:

When you click the send button, your order will automatically be
e-mailed to A.Y. McDonald's Customer Service Department.