CONFIRMATION
OF PURCHASE ORDER
DATE
OF ORDER: ______________________
P.
O. # (IF APPLICABLE): _______________
BILL TO:
SHIP TO:
____________________________________ ______________________________
____________________________________ ______________________________
____________________________________ ______________________________
____________________________________ ______________________________
PRODUCT: DISCOUNT: ___________________
TERMS: ______________________
QUANTITY: ___________________
NO CHARGE OFFSET PRODUCT: _________ ($__________) @
RETAIL VALUE.
SYSTEM: NET COST: _____________________
TERMS: ________________________
FREIGHT FOR PRODUCT AND SYSTEM:
_______________________
SHIP DATE: (Pending credit approval):
___________________________
______________________ ___________________
_________________
Authorized Signature Title Date
Please complete and return to
______________________________ Sales Department
FAX # ____-____-_______
THIS ORDER WILL BE HELD UNTIL RECEIPT OF THIS SIGNED
FORM.
Thank You.
