Order by FAX or Mail

Use this form to order by FAX or mail from the PHI On-Line website. You can either print out the form and write in your order, or type the information into the form before you print it out. The order form should be displayed in a separate browser window from the website, so you can save typing by electronically copying product part number(s) and description(s) from any product page, and pasting them into the form.

Any information you entered or copied will appear on the form when you print it out. Just FAX the printed form to (201) 791-3582 or mail it to PHI, 280 Midland Avenue, Building G-1, Saddle Brook, NJ 07663.

Easy instructions on

• How to cut and paste
• How to complete this form, and
• How to save time on future orders by opening a PHI account

NOTE: Please click here before printing the form 

1 ITEMS ORDERED Item # Qty Description Unit Price Total Price * Appropriate sales tax & shipping will be added to your order. Subtotal * 2 SHIPPING METHOD UPS ground      UPS overnight   Common Carrier Hold for pickup on    Date //   Time :   Location of pickup:  Saddle Brook  So. Plainfield  Ronkonkoma Other  3 Order Acknowledgement Please enter fax number. Order acknowledgement will be sent by fax. Contact Name  Fax   (  )  4 ENTER ACCOUNT # If you have an active PHI account you may enter your account # instead of completing the shipping and billing information below. Any information you enter will override your default shipping and billing choices. Account #  Phone  (  )   ext  [Required for verification] 5 SHIPPING INFORMATION Company Attention Address Address City   State   ZIP  Phone  (   )   ext  6 BILLING INFORMATION CHECK ENCLOSED OPEN ACCOUNT (prior credit approval required)   MC    VISA    Amex     Exp. /  Name on card:  Card number:  Signature:_________________________________________ Fax credit application for future purchases to: () 7 Please Sign Order  Print Name  Signature   _______________________________________