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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 ?__________________________ |
DATE:_______________________ Purchase Order Number:__________________
BILL TO:Company:_____________________________________CONTACT:__________________________________
Street Address:
____________________________________________________________________________________
City, State, Zip:_____________________________________________________________________________________
| **BLIND SHIP** | Yes or No |
SHIP TO:Company:_________________________________CONTACT:_________________________________
Street address:_________________________________________________________________________________
City, State, Zip:
________________________________________________________________________________
Buyer Contact:_____________________Phone#:________________ext.________Fax#:____________________
Technical Contact:________________Phone#:__________________ext._______Fax#:_____________________
| MFG PN# / Model | Quantity | Description | Unit Price | Total | Warranty / Condition |
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:__________________________________________________________
____________________________________________________________________