|
Company Name |
_____________________________________________________ |
|
Bill
to Address |
_____________________________________________________ |
|
Ship to Address (if
different) |
_____________________________________________________ |
|
Phone Number
(Point of Contact) |
_____________________________________________________ |
|
Antex Product Model
Number (Name) |
_____________________________________________________ |
|
Serial number
off the product(s) |
_____________________________________________________ |
|
Detailed Problem with the
product(s). |
_____________________________________________________ |
|
_______________________________________________________________ |
_____________________________________________________ |
|
_______________________________________________________________ |
_____________________________________________________ |
|
|
|
|
Method of
payment
i.e. Amex, Visa, MasterCard, C.O.D., Net 30, Wire Transfer. |
_____________________________________________________ |
|
Credit Card
Information
i.e. Type of card, Expiration Date, Name on the Card.
|
_____________________________________________________ |
|
Method of
Shipment
i.e. Fed-Ex, UPS, LEP, DHL· Any special instruction
customer may have. |
_____________________________________________________ |
