Order Form Date: _____/_____/ 20____
PO #: ____________________ Date Required: ______/______/ ______
Is this a Rush?
Sales Rep or Distributor: ______________________________ Sales Order #: SO#_________________
Yes or No
Company Name: ___________________________________________ * All new accounts will have to fill out a Credit Application. If items are needed immediately, please contact Customer Service or order Online.
Bill To Address
Ship To Address
Address: _______________________________
Address: _______________________________
City: _____________ State: ____ Zip: _______
City: _____________ State: ____ Zip: _______
Attention: ______________________________
Attention: ______________________________
Phone #: (______)________________________
Phone #: (______)________________________
Fax #: (________)________________________
Fax #: (____)______________________
Email: ______________@__________________
Email: ______________@__________________
Ship to Billing Address
QTY
EA / CS
Item #
Description
Price
Rewards Coupon Code
Note: _____________________________________ Signature: _________________ Date: _____/_____/ _______ Pricing: Please see our current Price List. Our prices are subject to change without notice. All prices are F.O.B. Maiden, NC (except where noted on Sales Order). All prices are in U.S. Dollars. Minimums: We have a NO minimum order policy.
Back Orders: In the event that any item is out of stock we will notify you the same day or the next day after your order ships.
Shipping: We ship with UPS or Federal Express Ground in 1 to 3 business days.
Return Policy: Errors must be reported in 10 business days or 60 days to return with 25% restock fee.
Open Account Payment Terms: Open Accounts are Net 30 days from the date of shipment. We accept MASTERCARD®, VISA® and American Express® credit cards. New Account Payment Terms: Please contact Customer Service to establish credit ( 1 to 2 weeks wait ) We also accept MASTERCARD®, VISA® and American Express® credit cards. Hours: Our Corporate Office / Customer Service opens at 8am – 5pm ( East Coast ) Monday - Friday. Mailing: PO Box 368 Maiden NC 28650 USA
Ship To: 4372 Providence Mill Rd 28650 USA
Website: www.touchupsolutions.com
E-mail: wecare@touchupsolutions.com
Telephone #: 828.428.9094 / Toll Free: 1.877.346.4747
Please fax your order to: 828.428.9970 rev. 1/25/09 (tp)
Thank YOU for your order!!!!
Po Box 368 Maiden, NC 28650 Tel: 828-428-9094 Fax: 828-428-9970
Credit Application
Company Name: ____________________________________________ A/P Contact: ________________________________ Address: _______________________________________ City: ______________________ State: _______ Zip: ____________ Phone #: _____________________ Fax #: ___________________ Email: _________________ D & B #: _________________ Years in Business: ______ Year Started: _____ Form of Business: ___ Sole Proprietor ___ Partnership ____ LLC ___ LLP * Form of Business: ___ Sole Proprietor ___ Partnership ____ LLC ___ LLP *State of Incorporation ____________ Federal ID #: ____________________ Tax Exempt: ___ Yes ___ No (If yes attach exempt form) Annual Sales: ____________________________________ Number of Employees: ____________
Owners / Officers / Partners Name: _______________________________________ Title: _________________________ Email: _______________________ Name: _______________________________________ Title: _________________________ Email: _______________________ Name: _______________________________________ Title: _________________________ Email: _______________________
Bank References 1. Bank Name: ______________________________ Contact: ________________________ Contact Phone #: ______________ Address: _________________________________________________________________________________________________ Account #: ______________________ Contact Phone #: ______________________ Contact Fax #: ______________________ 2. Bank Name: ____________________________ Contact: ________________________ Contact Phone #: ________________ Address: _________________________________________________________________________________________________ Account #: ______________________ Contact Phone #: ______________________ Contact Fax #: ______________________
Trade References 1. Company Name: ___________________________Contact: ________________________ Contact Phone #: _____________ Address: _________________________________________________________________________________________________ Account #: ______________________ Contact Phone #: ______________________ Contact Fax #: ______________________ 2. Company Name: ____________________________Contact: ________________________ Contact Phone #: _____________ Address: _________________________________________________________________________________________________ Account #: ______________________ Contact Phone #: ______________________ Contact Fax #: ______________________ 3. Company Name: ____________________________Contact: ________________________ Contact Phone #: _____________ Address: _________________________________________________________________________________________________ Account #: ______________________ Contact Phone #: ______________________ Contact Fax #: ______________________
Authorization to Release Information Date: ___________ Firm Name: _________________ Address: __________________________________ Authorized By: ___________________________ Name: ____________________ Title: _______________ rev. 2/19/09 (tp)