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FAX PARTS ORDER FORM
FAX # 414-354-7905
Account# ____________________________________
Bill to: ______________________________________
____________________________________________
____________________________________________
Date:________________________________________
Phone#______________________________________
Ship to:______________________________________
____________________________________________
____________________________________________
Attention:
P.O. ________________________________________
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 ________________________________________________