Order Form
DATE
P.O. #
BILL TO
SHIP TO (If other than Bill To)
Name
Name
VISA
MASTERCARD
Company
Company
Phone
E-Mail
DISCOVER
AMEX
Exp. Date
Card No.
Address
Address
City
State
Phone
Issuing Bank
Zip
Fax
Name (As It
Appears on Card)
City
State
Zip
Open Account Terms Available
with Credit Approval.
Signature
Freight Choices: UPS Ground
Model Number
Qty.
UPS Blue (2-Day)
UPS Orange (3-Day)
UPS Red (Overnight)
Other
Description
Fax Back to: 201-814-0510
Toll Free Phone: 800-526-0242
E-Mail to: [email protected]
Unit Price
Total
©2015 Comprehensive, a
Division of Vcom IMC. All
trademarks are property of
owners. All rights reserved.
80 Little Falls Road, Fairfield, NJ 07004
Save Time - Order Online at www.ComprehensiveCo.com