SALES ORDER FORM

Customer No:
Invoice No:
P.O. No. 
Customer:
Ship To:
Phone No:
Fax No:
Email Address:
Order Date:
Contact:
Needed By:
Ordered By:
Ship Via:
Category:
  Item No. Quantity Price Weight Remarks
1.
2.
3.
4.
5.
6.
7.
8.
9.

 

Freight Paid By:

Cust.

Adex

F.O.B.
UPS Zone:
Total Weight:
Freight Amount:
Freight Total:
Notes:
Sales Order No:

NO MINIMUM ORDER REQUIRED
 VISA & MASTERCARD ACCEPTED
TAXES: All applicable taxes are required by law.

For more information about any of our products,
please contact our Customer Service Department

In the U.S.A. phone: (800) 873-4776
 Outside the U.S.A. phone: (951) 653-9122
 Fax: (951) 653-9133
 E-mail at sales@adexmed.com

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