Please fill out completely
Date: ______________________________
Account: ___________________________
Bill to: _____________________________
___________________________________
___________________________________
___________________________________
Purchase Order Number ______________
**All orders MUST have a Purchase Order Number
Part Number
All backordered parts will be shipped when available via the same ship method as original order unless noted
below:
-
Ship complete order only - no backorders
-
Ship all available parts and contact customer on disposition of backordered parts
-
other (please specify)
___________________________________________________________________
Description
Service Parts Order Form
Fax to 559-263-9631
Ordered By: _________________________
Your Fax No.: _______________________
Ship to: ____________________________
___________________________________
___________________________________
___________________________________
Ship VIA___________________________
**Fed Ex shipments require Fed Ex account number
Quantity
Price
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