Account Number:
Phone:
Ship Via:
Product Information
Bill To Address:
Ship To Address:
3/14/2007: 11:59 AM
PLS ships all units via UPS Ground.
Quantity:
Projector Lamp Services is not responsible for any lamps received and left without the proper paperwork (ie.
Company Information
Fax:
(Signature of cardholder if name on card is different than contact name above)
50 Orville Drive
Name on Card:
PLS order form w disclaimer.xls Rev. B
Name:
PLEASE INCLUDE TAX EXEMPT CERTIFICATE IF APPLICABLE
Company Name:
E-mail:
Additional charges apply
Model:
Contact Information
Projector Make:
Payment Information
Any other shipping requests may require an extra charge.
Title:
Bohemia, NY 11716
Projector Lamp Services
Notes/ Special Requests/ Pricing Details:
Fax: 1-631-244-0053
3 or 4 Digit Security Code:
Other Service: (Specify Service)
send in a completed order form or company PO with your lamp(s).
order form or company PO) for more than 14 days. Lamps left for more than 14 days may be recycled. Always
Authorization
PLS Sales Rep:
Sign here:
Expiration Date:
Direct Line:
Payment Terms:
1 of 1
Insurance? (Y/N)
PLS: Sales
Phone: 1-631-244-0051
Return Shipping Information
Website:
(Customer Signature)
ReLamping?: (Y/N)
Quantity:
Type of Credit Card:
ReLamping Order Form
PO #:
[Pag.1]
Esta version es la html del arhivo pdf order, genearada por domotica.name desde www.relampit.com
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