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PURCHASE ORDER FAX FORM

Please fill out this form online, print it, sign it and fax it to CBS sales department at 763-478-3965. Although we have this page on a secure site, please do not email this form. Signature is required for all purchases.

Purchase Order #:

 Purchaser Name:
Date: Company Name:
Telephone: Street Address:
Fax: City:
Blind Drop Ship?

yes            no

 State:
(Ship To) Company Name: Zip Code:
(Ship To) Street: Zip Code:
(Ship To) City: Shipping Method:

(Ship To) State: If other, specify:

(Ship To): Zip Code:

 Freight Acct. #:
Payment Method: Charge Freight To:

 
QTY PART # MODEL/DESCRIPTION PRICE EACH TOTAL

If paying by credit card, please fill out the following:

Name on Card:

Street Address
Card Number: City:
Validation Security Code: State, Zip
Expiration Date:    

 

Credit Card Authorized Signature: _____________________________________   Date: ________________

 

Purchase Order Approval: ___________________________________________   Date: ________________

 

Computer Buying Solutions - 9915 13th Avenue North, Plymouth, MN 55441

Tel: 763-478-8788  Fax: 763-478-3965

 

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All Rights Reserved

 

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