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Kit Order Form


Jurisdictions Served
Size of Kit 100
200
300
400
500
Other Amount
 
Requested Delivery Date : (mm/dd/yy)
Shipping Method:
Regular Ground - 7/10 days
Priority - 3/4 days
Express - 1/2 days
I am a returning customer. Information below may be omitted, except for changes
Company name:
Branch:
*Contact name:
*Telephone(XXX-XXX-XXXX):
*Email Address:
Ship TO:
Company
Attention
Address
City
State
Zip
Bill TO:Use Shipping Info
Company
Attention
Address
City
State
Zip
Payment Method:
Visa or Master Card - We will send you and Order Acknowledgement Form if necessary which must be faxed back when completed.
Established Customers P.O. No:
Authorizing Party:
Customer Type:
Elevator Contractor, Consultant or Inspection Company
University Elevator Shop or In-house maintenance organization
Building Owner/Manager/Agent
Please send me a quote first via: email fax phone
Fax (XXX-XXX-XXXX):
Please complete the section above and then click Submit Order once. You will see the order as submitted. You will be contacted shortly.
 
 
 
Technical Support: John@codedataplate.com
(281)257-0516