To reorder SECUR-PAK™, print this page, fill it out, and Fax it to:
(203) 762-2548
If you are not an existing SECUR-PAK™customer,
and would like to place an order please call (203) 762-1902, or email
(sales@securpak.com).
Thank you.
Order Date: ____________________
Customer Number:________________(please refer to your last invoice)
Company Name:___________________________________________
Billing Address:
Attn.:___________________________________
Street:________________________________________________
City : ________________________________________________
State: _______
Shipping Address:
Attn.:___________________________________
Street:________________________________________________
City : ________________________________________________
State: _______
Contact Info:
Authorized Order Person: _________________________________
Phone Number: (______) _____ -- _______
Fax Number: (______) _____ -- _______
Product Information:
Purchase Order (PO) Number:_______________________
| SECUR-PAK™Number (please refer to your last invoice) |
Your Item Number
|
Quantity |
Description |
Price |
TOTAL |
|
|
|
|
Special Instructions:
Authorized Signature: ________________________________
Fax this form to:
Kemco Sales LLC
Attn.: Sales Department
(203) 762-2548
If you have trouble, or do not know any of the necessary information please call (203)762-1902