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Purchase by Fax
TO: EZ Systems
3480 W. Warner Ave. #A
Santa Ana, CA 92704
Tel:714-662-4959
Fax:714-662-6859
http://www.ezsystems.com |
My Email Address ?_______________________________ How did you find us ?__________________________
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DATE:_______________________ Purchase Order
Number:__________________
BILL TO:Company:_____________________________________CONTACT:__________________________________
Street Address:
____________________________________________________________________________________
City, State, Zip:_____________________________________________________________________________________
SHIP TO:Company:_________________________________CONTACT:_________________________________
Street address:_________________________________________________________________________________
City, State, Zip:
________________________________________________________________________________
Buyer Contact:_____________________Phone#:________________ext.________Fax#:____________________
Technical Contact:________________Phone#:__________________ext._______Fax#:_____________________
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Quantity |
Description |
Unit
Price |
Total |
Warranty / Condition |
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Terms:_______ Credit Card#:___________________________________Exp:_________Holder
Name:_____________________________
Shipping UPS or Fedx: _________________ Overnight:________ 2 Day:________ 3
Day:_______ Ground:________
My UPS / Fedx Account #:__________________Bill me Yes or No:______
COMMENTS:__________________________________________________________
____________________________________________________________________
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