...............................Addenda Order
Form.................................................
...........................(Fax to:
831-372-6192, or email to: purch.orders at
addenda.com).............
Name: _________________________________________________ Date: _______________
Company Name: _____________________________________________________________
Phone #: _______________________________ Fax #: ______________________________
Email Address: ____________________________________________ (for order confirmations)
Billing Address To:________________________________________________________
Street: _____________________________________________________________________
City, State, Zip or Country Code:_________________________________________________
Shipping Address To:_____________________________________________________
Street: _____________________________________________________________________
City, State, Zip or Country Code:_________________________________________________
Purchase Order #: (existing customers only) _________________________________________
OR Card #: (Visa, M/C, Amex) _____________________________________ Exp: ________
Name on Card: ____________________________________ Billing Zipcode:______________
Signature: __________________________________________________________________
|
Qty |
Addenda model# |
Description |
Price Each ($ USD) |
Total ($ USD) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Shipping Service (circle one): |
UPS |
FedEx |
Other____________ |
|
Shipping Options: |
1 Day |
2 Day |
3 Day |
Ground |
|
Arrival Time: |
AM |
PM |
Required Date: ________________________ Other: _______________________________
** International Customers: Please include your FedEx account number for billing of duties, taxes, VAT, and/or customs. Otherwise, we will respond with a Pro Forma Invoice for your approval, including shipping via United Parcel Service. Addenda Electronics will not ship overseas via FedEx without a customer's account number. **