FAX PARTS ORDER FORM
FAX
#
414-354-7905
Account# ______________________________________
Ship to: ______________________________________
Bill to: ________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
Attention:
Date: __________________________________________
P.O. __________________________________________
Phone#________________________________________
Fax#__________________________________________
PART#
COLOR
QTY
DESCRIPTION
MODEL
SERIAL
UNIT IN
NUMBER
WARRANTY?
SPECIAL INSTRUCTIONS:
All part shipments will be sent ground delivery.
We have air shipment available at an additional cost to you.
Next Day Air
2nd Day Air
3 Day Select
If you do not have an open account with us your order will be shipped C.O.D.
COMMENTS: ____________________________________________________________________________________
________________________________________________________________________________________________
Authorized By ________________________________________________