rev. 1/25/09 (tp)

Date: _____/_____/ 20____ PO #: ____________________ Date Required: ______/______/ ______ Sales Rep or Distributor: ______________________________ Sales Order #: SO#_________________

Company Name: ___________________________________________ * All new accounts will have to fill out a Credit Application. If items are needed immediately, please contact Customer Service or order Online.

Address: _______________________________ Address: _______________________________

City: _____________ State: ____ Zip: _______ City: _____________ State: ____ Zip: _______

Attention: ______________________________ Attention: ______________________________

Phone #: (______)________________________ Phone #: (______)________________________

Fax #: (________)________________________ Fax #: (____)______________________

Email: ______________@__________________ Email: ______________@__________________ Ship to Billing Address

QTY EA / CS Item # Description Price Rewards Coupon Code

Note: _____________________________________ Signature: _________________ Date: _____/_____/ _______

Pricing: Please see our current Price List. Our prices are subject to change without notice. All prices are F.O.B. Maiden, NC (except where noted on Sales Order). All prices are in U.S. Dollars.

Minimums: We have a NO minimum order policy. Back Orders: In the event that any item is out of stock we will notify you the same day or the next day after your order ships.

Shipping: We ship with UPS or Federal Express Ground in 1 to 3 business days. Return Policy: Errors must be reported in 10 business days or 60 days to return with 25% restock fee.

Open Account Payment Terms: Open Accounts are Net 30 days from the date of shipment. We accept MASTERCARD®, VISA® and American Express® credit cards.

New Account Payment Terms: Please contact Customer Service to establish credit ( 1 to 2 weeks wait ) We also accept MASTERCARD®, VISA® and American Express® credit cards.

Hours: Our Corporate Office / Customer Service opens at 8am – 5pm ( East Coast ) Monday - Friday.

Mailing: PO Box 368 Maiden NC 28650 USA Ship To: 4372 Providence Mill Rd 28650 USA Website: www.touchupsolutions.com E-mail: wecare@touchupsolutions.com

Telephone #: 828.428.9094 / Toll Free: 1.877.346.4747

Please fax your order to: 828.428.9970 Thank YOU for your order!!!!

Order Form

Ship To Address Bill To Address

Is this a Rush?

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