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

Open the PDF directly: View PDF .
Page Count: 1

New Customer Set-Up – Order Form

Customer Details – Please provide information requested below and FAX to 714-992-0471

Company: Contact

Name:

Ship To

Address:

Phone

Number: Ext.:

City/Sate/Zip:

Fax

Number: Cell:

ATTN:

Email:

Date

Requested:

Requested By:

Check all that apply:

___RUSH – Urgent Requirement

___Review Possible Substitutions

___Quote

Billing Information:

(if different from

Ship To address)

Purchase Order:

(optional)

Billing

Contact: Phone:

Terms: FOB is Anaheim, California, shipped uninsured unless

specified “Insured” and accept additional fees

Shipping Method:

The default shipping method is UPS g ound service

,

prepaid and added to the invoice, unless specified below

r

Payment: Choose payment options from below

_____Net 30 Days, Established Accounts Only _____COD

Credit Card – MasterCard, VISA, Discover and American Express accepted

Card

Number:____________________________________________________

Name

On Card:____________________________________________________

Expiration Zip Code

Date:____________________ on Card:______________________

UPS: _____1 day _____2 day _____ 3 day

UPS Collect Account #_________________________________________

(optional)

FedEx: _____1 day _____2 day _____ 3 day

FedEx Collect Account #_______________________________________

(optional)

California Customers: ____Taxable, as applicable ____Resale: Resale Certificate on file: ____yes ____no, please send forms

Model Number

One item per Line

Description Quantity Price Each

For internal use only – Customers do not supply information below

Sales Order#

Issued By:

Date

Issued:

SPECIAL NOTES:

Thank You!

www.anaheimautomation.com 714-992-6990 714-992-0471, Fax

910 East Orangefair Lane Anaheim, CA 92801 USA

Print Form

Submit by Email