Spare parts order, Fluid management parts order form, Mail or fax orders to – Fluid Management Miller GyroMixer User Manual
Page 10
INTRODUCTION
6
SPARE PARTS ORDER
Fluid Management Parts Order Form
Photocopy and use this form to
Mail or fax orders to:
IDEX
Phone:
1(800) 462-2466
1023 Wheeling Road
| Fax:
1(847) 537-5530
Wheeling, IL 60090
|
|
Sold To:
Ship To:
________________________ ________________________
________________________ ________________________
________________________ ________________________
________________________ ________________________
Purchase Order Number_________________
Ship Via: ______________________
Collect
Prepaid
Taxable
Tax Exempt
(Fax copy of exemption certificate.)
QUANTITY
PART
NUMBER
DESCRIPTION
UNIT
PRICE
S
S
S
S
S
S
S
S
S
S
S
Comments:
____________________________________________________
____________________________________________________
____________________________________________________
_________________________________________________
Signature
______________
Date: