U-Line CLRCO2075

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FAX PARTS ORDER FORM

FAX # 414-354-7905

Account# ____________________________________

Bill to: ______________________________________

____________________________________________

Date:________________________________________

Phone#______________________________________

Ship to:______________________________________

____________________________________________

Attention:

P.O. ________________________________________

Fax# ________________________________________

PART# COLOR QTY DESCRIPTION MODEL SERIAL UNIT IN

NUMBER WARRANTY?

SPECIAL INSTRUCTIONS:

All part shipments will be sent ground delivery.

We have air shipment available at an additional cost to you.

Next Day Air 2nd Day Air 3 Day Select

If you do not have an open account with us your order will be shipped C.O.D.

COMMENTS: ________________________________________________________________________________

____________________________________________________________________________________________

Authorized By ____________________________________________

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