5614 S.W. 25th Street, Hollywood, FL 33023, Ph: 954-966-7329,
Fax: 954-966-3584
Fax Order Form
Directions: (1) Type info into blank fields, (2) Print it out, (3) Fax it.
BILL TO:
(Check Name or Company for Billing Purposes) PO#
Name:
Company:
Address:
City:
State:
Zip:
Country:
Phone:
Fax:
Charge Card: (check one)
Visa
MasterCard
Amex
Discover
Card Number:
Expiration Date:
Security Code:
Cell:
Email:
SHIP TO:
(if different from billing address) AC Tail # or Boat Name:
Name:
Company:
Address:
City:
State:
Zip:
Country:
Phone:
Fax:
Cell:
Qty.
Part Number
Description
Price (Check One)
Buy
Rent
Service
Total:
Note:
Rental Charge begins on the day item(s) leave our facility through the date the items arrive back to our facility regardless of what time they are picked up or returned. Rentals are a 2-Day minimum. Rental cancellations are due at least 48 hours in advance.
FOR PURCHASE:
Specify if needed by a particular trip date:
FOR SERVICE:
Regular T.A. (Approx. 2-3 weeks).
Expedite 25% Additional (Approx. 2-3 days)
Date needed by:
FOR RENTAL:
Date Needed:
*Approx. Return Date:
DELIVERY:
UPS Ground
Next Day
Second Day
Third Day
Customer Pickup
Special Shipping Instructions:
Signature:______________________________________ Date:
Name:
Note:
For shipping back rentals or service work, call our Shipping Rep., Jeff Heidenreich at Freightquote.com.
Ph: 800-323-5441 x1732, Fax: 913-319-0635, or Email:
jheidenreich@freightquote.com
for best price.
PRINT OUT & FAX TO: 954 966 3584.
(PLEASE CALL OR EMAIL US TO CONFIRM ORDER WAS RECEIVED.)