Customer Order Form

We will be glad to accept your order via Phone, Fax or Email!

Phone: 978-739-4883
Fax: 978-739-5640

Ordering and Shipping Information

To order by credit card, please call us @ 978-739-4883 (not a secure website)

Bill To

Facility Name:

Attention:

Bldg/RM

Address 1:

Address 2:

City:

State:

Postal Code:

Country:

 

Ship To

Facility Name:

Bldg/RM

Address 1:

Address 2:

City:

State:

Postal Code:

Country:

Buyer Name:

Phone:

Fax: (for order confirmation and pricing)

E-mail:

Account Number:

PO Number:

Invoice Terms:(check one)
Open account:
Credit Card:

 (please telephone credit card info [not a secure website] )

Preferred Method of Shipment:
UPS UPS Next Day UPS Second Day
FedEx RPS  

Common Carrier (please specify)

Other (please specify)

QUANTITY SIZE ITEM NUM. PRODUCT DESCRIPTION








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