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FAX ORDER FORM
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INDEPENDENT AG EQUIPMENT PRODUCT CATALOG
| PA: 800-345-3546 | OH: 800-848-8460 | IN: 888-563-1988 |
www.IndependentAg.comWarehouse Codes
:
PA
-Biglerville, PA,
OH
-Bellevue, OH,
IN
-Bunker Hill, IN and
B/O
-Back order
AVAIL CATALOG YEAR UNIT EXTENDED
QUANTITY PART NO.
DESCRIPTION
WHSE AND PAGE NO.
PRICE PRICE
Purchase Order No.: __________________________________________________
Bill to: ______________________________________________________________
Company Name: ______________________________________________________
Address: ____________________________________________________________
City, State, Zip: ______________________________________________________
Phone No.: __________________________________________________________
Fax No.: ____________________________________________________________
E-mail:______________________________________________________________
Ship to:
____________________________________________________________
Company Name: ______________________________________________________
Attention:____________________________________________________________
Address: ____________________________________________________________
City, State, Zip: ______________________________________________________
Ship via:
COD UPS ground Mail
Next day air
2nd day air
Best way Truck
Visa, Mastercard, American Express
Discover or Farm Plan No.: __________________________________________________________________ EXP. DATE: __________________
Attention:
________________________________
Order Date: __________________ Time Faxed: ________________________ Customer Number:
____________
Ship complete orders
Ship from any available warehouse
Ok to back order
Special instructions:
____________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Please call
or fax back with a total of this order. Attention: ____________________________________________________
Please notify me if part numbers need to be back ordered