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 (add $2.80) - 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 CREDIT CARD, SPECIFY:   ___ VISA  ___MasterCard  ___AMEX

Card No:  ____________________________________________

Expiration Date______________

Print Cardholder's Name _____________________________

Cardholder's Address _______________________________

____________________________________________
CALCULATE YOUR SHIPPING
Add the appropriate amount to your order (plus a $2.55 UPS surcharge for residential delivery).
Up to $15.00$7.00
$15.01 to $25.00$9.50
$$25.01 to $45.00$12.00
$45.01 to $65.00$16.00
$65.01 to $90.00$19.50
$90.01 to $125.00$25.00
$125.01 to $200.00$31.00
$200.01 & over20%


CLICK TO LOOK at additional products before ordering!

** UPS will not deliver without a street address.

All orders shipped UPS Ground unless customer requests other method.

Continental USA Only
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