Good Water Warehouse
FAX ORDER FORM
Corporate Office TEL: (714) 441-2893 TOLL-FREE TEL: (800) 749-0252 TOLL-FREE FAX: (800) 749-0331 |
Canadian Office TEL: (403) 252-7972 TOLL-FREE TEL: (888) 668-1234 TOLL-FREE FAX: (888) 227-3291 |
| Date: ____/____/______ Account #: ___________
Purchase Order # (Required): ___________ Purchaser’s name: ________________ |
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Billing Address: |
Shipping Address: Company Name _____________________________________ Address: ___________________________________________ City: ___________________________ State/Province:______ Zip/Postal Code: _________________ Country:____________ Phone: (_____)______________________________________ Fax: (_____)________________________________________ |
| County:______________ (Required
if in California) |
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| Payment: NET 30 (On Approved Credit) - UPS COD -
Credit Card VISA/Master Card #: ________-________-________-________ Exp. Date: _____/_____/________ Request Order Confirmation Via Fax: [Yes - No] Partial Ship: [Yes - No] Ship via: [UPS Ground -- 3 Day Select -- 2nd Day -- Next Day] Other____________________ Special instructions: (minimum order accepted is $100.00 net, exclusive of freight) _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ |
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Total Price |
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