Fluid Management NSC80 Harbil - Manual (Page 15)

NSC80 Operating & Instruction Manual 15
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 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
Comments:
_________________________________________________
Signature ______________
Date