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Super
Safety Order Form
Tell us what
you want to order phone it in at (800) 275-8239 This page is under construction for E-commerce email
WEBMASTER
International
Number USA (800) 275-8239 FAX this
to (773) 538-8080
Company
Name:__________________________________________
Address:________________________________________________
City:
_______________________________ State:
________________________
Zip:
_______________________________
Telephone & of name
of Buyer: _________________________________________ Email _____________
Telephone & and name
of Accounts Payable Person: ________________________ Email
_____________
Ship to Address
Must be same address on credit card unless
credit application is on file.
SAME AS ABOVE CHECK HERE
□
Name and Company:
_____________________________________________________________
Address:_______________________________________________________________________
City:
_______________________________ State:
________________________ ZIP: ________________
Specifications:__________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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Part Number |
Item Name |
Description if Applicable |
Quantity |
Cost |
Some items may have minimums.
Payment: Credit Card, Company Check (must
be cleared or guaranteed with PO), or Cash, money order or cashiers check.
You must provide a phone and we only ship to address on credit card! without
a credit application (allow 10 days to process / international may be
longer). Thank you! Some items may have minimums,
restocking charges beyond our control from manufacturer, shipping VAT,
tax, our re-stocking fee 25% and any other costs incurred directly by
us to accommodate your special needs. Credit cards only verified
credit card addresses will be shipped too. Please allow two weeks for delivery.
Expedited shipping let us know additional charges will apply for
overnight shipment will depend on orders going in before 1:30 in most
cases it will ship the next day. We do not guarantee delivery
times or dates (we do the best reasonably to get your items out
fast). We ship Federal Express worldwide or Roadway Freight.
Signed X: ________________________________
Date:___________
Credit Card Type:
_______________________________
Credit Card Address:
________________________________________
City: ____________________ State: _____________ Country:
_____________________Zip:
____________
Credit Card Number:
_________________________
Expiration date:________
CV2 or Security No ______
Credit Card Number:
_________________________
Expiration date:________
CV2 or Security No ______
Credit Card Number:
_________________________
Expiration date:________
CV2 or Security No ______
Cardholders Telephone:
________________________________ Email: _____________________
_______________________________________________________________________________
_______________________________________________________________________________
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