Account# ____________________________________
Bill to: ______________________________________
____________________________________________
____________________________________________
Date:________________________________________
Phone#______________________________________
PART#
COLOR
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
If you do not have an open account with us your order will be shipped C.O.D.
COMMENTS: ________________________________________________________________________________
____________________________________________________________________________________________
FAX PARTS ORDER FORM
FAX # 414-354-7905
QTY
DESCRIPTION
3 Day Select
Authorized By ________________________________________________
115
Ship to:______________________________________
____________________________________________
____________________________________________
Attention:
P.O. ________________________________________
Fax# ________________________________________
MODEL
SERIAL
UNIT IN
NUMBER
WARRANTY?