U-Line Combo 75 Frost Free - Fax Parts Order Form

FAX PARTS ORDER FORM
FAX # 414-354-7905
Account# ______________________________________ Ship to: ______________________________________
Bill to: ________________________________________ ______________________________________________
______________________________________________ ______________________________________________
______________________________________________ Attention:
Date: __________________________________________ P.O. __________________________________________
Phone#________________________________________ 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 ________________________________________________