Purchase Order Request

To order parts with your approved Purchase Order #, please complete the following form.

NOTE: Items marked by * are required.

 

Organization: *  
Contact Person: *  
Phone Number: *  
E-mail address: *  
Billing Address 1: *  
Billing Address 2:  
Billing City: *  
Billing State: *  
Billing ZipCode: *  
Is Shipping Address Same as Billing Address?:   Yes. If not the same, please provide Shipping Address:
Shipping Address 1:  
Shipping Address 2:  
Shipping City:  
Shipping State:  
Shipping ZipCode:  
 
Shipping Method: *  
Part Number: *  
Quantity: *  
Terms: *   Credit Card*    NET 10    NET 15    NET 30
  * Credit Card orders: please fax credit card info to 530-287-5200
   or call us at 530-272-8084, x202
Comments:  
 

 

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