Cameron Opti-Rip 415A-M1 - Parts Order Form

75
PARTS & SERVICE
PARTS &
SERVICE
#415-R1
8-15-18 - JR
75
PARTS &
SERVICE
4. Preferred Shipping Method:
(check one)
UPS Regular Truck Customer Pickup UPS Next Day Air
Carrier: _____________ Other:_______________ Air Freight
1. Sold to:
Company __________________________
Address ___________________________
Address ___________________________
City _______________________________
State _____ Zip _____________________
Your Name _________________________
Phone # ___________________________
Fax # ______________________________
Purchase Order # ___________________
2. Ship to:
Company __________________________
Address ___________________________
Address ___________________________
City _______________________________
State _____ Zip ____________________
Attention: __________________________
Phone # ___________________________
Fax # _____________________________
Purchase Order # ___________________
5. Fax, Mail, or
Phone your Order to:
Cameron Automation
130 Salt Point Turnpike
Poughkeepsie, NY 12603
Phone: (845) 452-3780
Fax: (845) 452-0764
Quantity
Part Name Description Price (each)
3. Parts Needed:
Parts Order Form