Order By Fax:		Order By Mail:
24 hrs/day 7 days/week		Comfort Scrubs
1.601.892.4610		1018 Industrial Drive
		Hazlehurst, MS 39083
SHIP TO ADDRESS:			MAILING ADDRESS
			(if different from shipping)
Name: _____________________			Name:  ____________________
Street:  ____________________			Street:  ____________________
City:  ______________________			City:  ______________________
State/Zip: __________________			State/Zip: __________________
Phone #: (_____)-____________			Phone #: (_____)____________
Fax #: (____)-_______________			Fax #: (____)_______________
Item # and Description	Color	Size	Quantity	Price Each	Total
___ Check    ___ Purchase Order  ___ Money Order				Subtotal:
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				Sales Tax:
Card #: ___________________  Exp. Date: _________
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Signature (required for all cards):				Grand Total:
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Shipping Method: (circle one)  UPS Ground  UPS 3 Day Select  UPS 2nd Day Air                                                 UPS Next Day Air
Please make check payable to: National Textile & Apparel
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Please fax or mail any suggestions on fabrics, items, or sizes that you would like to see on our website.