Choice Waterjet Parts Credit Application Page 4
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2
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4Parts Order #
Page:
Date:
Quality Waterjet Replacement Parts
Customer #:
Company Name:
Person Placing Order:
Street Address:
City:
State:
Zip Code:
Phone:
Fax:
Email:
Purchase Order #:
Tax Exempt:
Shipping: Ups Ground
Other:
Date Required:
Ship To Address (If Different From Above):
Ship To Contact Person:
Phone:
Payment: Acct. #
Exp:
Cc #
Code:
Part Number
Qty
Description
Each
Total
Parts Total
Does not include shipping/ tax
Phone: 763-497-8735
65
Fax: 763-497-8702
References to the Original Equipment Manufacturer’s name and part number is for identification purposes only
May 2015
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