Fluid Management H-5 Mixer Digital Timer - Manual (Page 31)

H-5 Paint Mixer Operating & Instruction Manual 31
SPARE PARTS ORDER
Fluid Management Parts Order Form
Photocopy and use this form to
Mail or Fax orders to:
Fluid Management A unit of IDEX | Phone: 1(800) 462-2466
1023 South Wheeling Road | Fax: 1(847) 537-5530
Wheeling, IL 60090 |
|
Sold To: Ship To:
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P.O. Number___________
PHONE # (___)___-____
Ship Via: ______________________ Collect Prepaid
Taxable Tax Exempt (Fax copy of exemption certificate.)
QUANTITY PART
NUMBER
DESCRIPTION UNIT
PRICE
Comments: ____________________________________________________
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_______________________ ________________________
Name
(Please print ) Signature
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Date: