Puchase Order Form

Date: May 23, 2012

 

Dealer information

Dealer: XYZ Inc. Phone number: 555-555-5555 Salesperson name: John Doe
Address: 123 Alphabet
Delta, Epsilon 123456
Fax number: 666-666-6666 Salesperson number: 1234A56
  E-mail: john.dealer@head.mars Salesperson E-mail: john.doe@head.mars

* All fields are required to be filled

Billing/Shipping Info

Bill to address: Ship to address:
   
   
Prepaid + Charge Collect Third Party Billing

Project information

Project Manager: Architectural firm:
Manager Phone: Firm location:
Project name:  
Project location:  
     
  Contractor:

Project details

New Retrofit

Please indicate ceiling OR beam height

Type of wall Wall letter Qty Wall length Ceiling height Beam height Motor Perimeter
seal color
(Classic only)
Panel reveal/
Joint color
(Classic only)
Finish Finish description Unit Price Total
If you are requesting information for an existing wall, please indicate the letter - if not, leave blank Total:
Currency of sale:

Other information

Indicate voltage & hertz
Yes No
Tentative delivery schedule:

Substantial completion date for the project
Quick Ship Program   Yes No
In order to qualify for this program and secure a slot in our production schedule, you must first meet all the requirements AND advised us of the shipment date. Requesting the Quick Ship Program DOES NOT guarantee there is a space available. The minimum manufacturing lead time from release and receipt of approved panel finish is 6 weeks.
Yes No


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