Midmark M9 - Fax Order Form

© Midmark Corporation 2003 SF-1803 Page 7-2 Printed in U.S.A.
FAX ORDERING FORM
(SERVICE PARTS ONLY)
Do not tear out this page. Photo copy this page for use only
NOTES:
• ALL AREAS MUST BE COMPLETED.
• USE FOR NON-WARRANTY FAX ORDERS ONLY. WARRANTY ORDERS MUST BE TELEPHONED IN (1 - 800 - MIDMARK).
ATTENTION: SERVICE DEPARTMENT FAX #: 877 - 249 - 1793
ACCT #
: P.O.# DATE: / /
NAME:
ADDRESS:
CITY, STATE:
ZIP CODE:
CONTACT:
PHONE:
SHIP TO:
NON-EMERGENCY ORDER - TO SHIP WITHIN 72 HOURS IF
PART(S) IN STOCK.
EMERGENCY ORDER - TO SHIP WITHIN 24 HOURS IF PART(S)
IN STOCK (IF ORDER RECEIVED BEFORE 1:30 P.M. E.S.T.).
SEND NOTIFICATION IF PARTS ARE NOT AVAILABLE TO SHIP
WITHIN 24 HOURS VIA E-MAIL OR FAX TO:
METHOD OF SHIPMENT
UPS FED EX OTHER:
NEXT DAY A.M. NEXT DAY A.M.
NEXT DAY P.M. NEXT DAY P.M.
2ND DAY 2ND DAY
GROUND ECONOMY
QTY PART NUMBER DESCRIPTION (SPECIFY COLOR OF ITEM IF APPLICABLE)
COLOR
CODE
PRICE /
PER
Total Cost: $
BLOCKED
Rev. 3/18/03
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