Customer Details – Please Provide Information Requested Below And FAX To 714 992 0471 Obtain RMA# New Set Up Order Form

User Manual: New Customer Set-Up Order Form

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DownloadCustomer Details – Please Provide Information Requested Below And FAX To 714-992-0471 Obtain RMA# New Set-Up Order Form
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New Customer Set-Up – Order Form
Customer Details – Please provide information requested below and FAX to 714-992-0471
Company:

Contact
Name:
Phone
Number:
Fax
Number:

Ship To
Address:
City/Sate/Zip:

Ext.:
Cell:

ATTN:
Date
Requested:

Check all that apply:
___RUSH – Urgent Requirement
___Review Possible Substitutions
___Quote

Requested By:

Purchase Order:
(optional)

Email:
Billing Information:
(if different from
Ship To address)

Billing
Contact:

Shipping Method: The default shipping method is UPS ground service,
prepaid and added to the invoice, unless specified below

Terms: FOB is Anaheim, California, shipped uninsured unless
specified “Insured” and accept additional fees

Payment: Choose payment options from below
_____Net 30 Days, Established Accounts Only

UPS: _____1 day

_____COD

_____2 day _____ 3 day

UPS Collect Account #_________________________________________
(optional)

Credit Card – MasterCard, VISA, Discover and American Express accepted
Card
Number:____________________________________________________
Name
On Card:____________________________________________________
Expiration
Zip Code
Date:____________________
on Card:______________________

California Customers: ____Taxable, as applicable

Phone:

FedEx: _____1 day

_____2 day _____ 3 day

FedEx Collect Account #_______________________________________
(optional)

____Resale: Resale Certificate on file: ____yes

Model Number
One item per Line

Description

____no, please send forms

Quantity

For internal use only – Customers do not supply information below
SPECIAL NOTES:

Sales Order#
Issued By:
Date
Issued:

Print Form

Thank You!

www.anaheimautomation.com

714-992-6990

Submit by Email
714-992-0471, Fax

910 East Orangefair Lane Anaheim, CA 92801 USA

Price Each
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Title                           : Customer Details – Please provide information requested below and FAX to 714-992-0471 to obtain RMA#
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