BAUM
BAUM
EASY-FAX Order Form
1660
Campbell
Road Fax
#:
1-800-452-0947
Sidney, OH 45365
or - 1-937-497-8301
PH: 1-800-543-6107
If you need information or assistance identifying part numbers please
-or- 1-937-778-9636
call our Parts department toll free at 800-543-6107 between the hours
of
8
a.m.
and
5
p.m.
EST
Customer Information : For Billing
Ship-to Information:
Acct #: ___________________
P.O. Nbr: __________________________
Company: ______________________________________
Company: _______________________________________
Contact: ______________________________________
Contact _______________________________________
Address: ______________________________________
Address:
_______________________________________
City / St: ______________________________________
City / St: _______________________________________
Zip:
_____________________
Zip:
_____________________
Phone:
_______________________________
Phone: _______________________________
IMPORTANT
: If you do not indicate order status, order will be assumed to be “Normal”
ORDER STATUS: Emergency Order ______
Rush Order ______
Normal Order ______
Qty
Part Number
Description
* Model# & Serial #
_____OK to ship C.O.D. if necessary
Shipping Instructions:
(mark only one)
_____UPS Ground _____UPS 2
nd
Day Air _____UPS Next Day _____Federal Express _____Truck ____Other ___________________
(Please specify)
Charge Card Information:
_____VISA
_____Mastercard Name on Card: ______________________________________________
Expiration Date: ____________ Phone #: ________________________
Card #: ____________________________________________________
* For Machines under Warranty you MUST supply Serial# and Model# above