FAX PARTS ORDER FORMFAX # 414-354-7905

Account# ____________________________________

Ship to:______________________________________

Bill to: ______________________________________

____________________________________________

____________________________________________

____________________________________________

____________________________________________

Attention:

 

 

 

Date:________________________________________

P.O. ________________________________________

Phone#______________________________________

Fax# ________________________________________

 

 

 

 

 

 

 

PART#COLORQTYDESCRIPTIONMODEL

SERIAL

UNIT IN

 

 

 

 

 

 

NUMBERWARRANTY?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SPECIAL INSTRUCTIONS:All part shipments will be sent ground delivery.We have air shipment available at an additional cost to you.
Next Day Air2nd Day Air3 Day Select
If you do not have an open account with us your order will be shipped C.O.D.

COMMENTS: ________________________________________________________________________________

____________________________________________________________________________________________

Authorized By ________________________________________________

65