VueTech Order Form
(Fax to: 831-372-6192)
Name: ________________________________ E-mail: _____________________________
Company Name: _________________________________________Date: _______________
Phone #: _______________________________ Fax #: ______________________________
Billing Address To:_________________________________________________________
Street: _____________________________________________________________________
City, State, Zip: ______________________________________________________________
Shipping Address To:_______________________________________________________
Street: _____________________________________________________________________
City, State, Zip: ______________________________________________________________
Purchase Order #: (existing customers only) ________________________________________
OR Card #: (Visa, M/C only) __________________________________ Expiration: _______
Name on Card: ____________________________________ Card Zipcode:_______________
Signature: __________________________________________________________________
| Qty | VueTech | Description | VTR | Special | Price | |
|---|---|---|---|---|---|---|
| model # | make/model | instructions | ($ USD) | |||
| Shipping Service: (circle one) | UPS | FedEx | Other____________ |
| Shipping Options: | 1 Day | 2 Day | 3 Day | Ground | Arrival Time: | AM | PM |
Other: ____________________________________________________________________
** International Customers: Please include your FedEx account number for billing of duties, taxes, VAT, and/or customs. Otherwise, we will respond with a Pro Forma Invoice for your approval. **