ORDER AND QUOTE FORM

 RANDOLPH,HALE & MEREDITH,INC.

319 STATE STREET

BOWLING GREEN, KY. 42101

 

Submit This Form To:

BILL TO ADDRESS (must be filled out)
Your Name:
Company Name:
Suite/Apt. Number:
Street Address:
City/Town:
State/Province:
Zip Code:
Country:
E-mail:
Telephone:
Fax:
SHIP TO ADDRESS (only if different from billing)
Your Name:
Company Name:
Suite/Apt. Number:
Street Address:
City/Town:
State/Province:
Zip Code:
Country:
E-mail:
Telephone:
Fax:

PAYMENT METHOD

OPEN ACCOUNT ORDERS

 
Purchase Order Number:
Company Name:
Account Number:
Contact Name:
Phone #

CREDIT CARD
Credit Card Type:
Credit Card Number:
Expiration Date:

Card Holder Information (if different from bill to information):
Name:
Address:
City/Town:
State/Province:
Zip/Postal Code:

**If you are uncomfortable about sending your creditcard info

over the web, just print this form and fax it.**

Randolph, Hale & Meredith, Inc. FAX: 1-800-822-1524

Quantity and Part Number must be filled out:

 

 Qty

Part#

Description

Price

SHIPPING METHOD:All orders entered here will ship via UPS ground unless otherwise specified.

We welcome any suggestions you have that would help us serve you better:

 

 

 

 

 

Copyright © 2002 Randolph, Hale & Meredith Inc.
Last modified: November 05, 2002