Oxbo Parts Order Form



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Date: Customer #: PO #:
Billing Address
Name:					Address:
City:					State/Prov:
Zip/Postal:					Country:
Shipping Address (if different from Billing)
Name:					Address:
City:					State/Prov:
Zip/Postal:					Country:
Contact Information
Contact Name:					Email address:
Phone:					Fax:
Remarks:
Please advise price & delivery
Line:	Qty:	Part#	Description	Ship Date:	Unit Cost
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Payment Options
Terms: All net orders must have approved credit. For a Credit Application, please click here.
How will you be making your payment? ($US dollars)
Open account, with approved credit
Cash in advance
MC/Visa (card on record or
Name on Card :
Card Number (numbers only): Exp. Date:
Shipping Information (sorry, no COD)
Please ship via:
Your UPS#: Your FedEx: Other shipping method:
Special Instructions: (refer to line number above)

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