Schaff Piano Product Catalog - page 183

183
NAME
ADDRESS
TOWN or CITY
STATE
ZIP
TYPE OF ORDER
CASH
OPEN ACCOUNT
CREDIT CARD
Remittance $
QUANTITY UNIT OF
MEASURE
CATALOG
NUMBER
DESCRIPTION
UNIT
PRICE
EXTENDED
PRICE
DATE
CUSTOMER P.O. NO.
Check here if this is a change of name or address.
Check here if this is your first order.
CREDIT TERMS
OFFICE USE ONLY
METHOD OF SHIPMENT
Mark X in square
which way to ship. If
not specified we will
use
our
best
judgement. Include
delivery and insurance
charges
with
remittance.
UPS GROUND
UPS NEXT DAY
UPS 2ND DAY
UPS 3-DAY
YOUR SCHAFF ACCT. NO.
NAME
PHONE
ADDRESS
TOWN or CITY
STATE
ZIP
BILL TO:
CARDHOLDER’S NAME
CARDHOLDER’S BILLING ADDRESS
CITY STATE ZIP
VISA MC CARD # EXPIRATION DATE
CARDHOLDER’S SIGNATURE
CREDIT CARD INFORMATION:
SHIP TO:
(IF DIFFERENT FROM BILLING ADDRESS)
PLEASE NOTE:
1. ACCOUNT NUMBER MUST BE FILLED IN ABOVE
2. HAVE YOU SIGNED THIS ORDER FORM?
Signed By
SCHAFF PIANO SUPPLY COMPANY
451 OAKWOOD ROAD, LAKE ZURICH, IL 60047
Phone: (847) 438-4556 Fax: (847) 438-4615
1-800-747-4266
E-mail:
SCHAFF PIANO
ORDER FORM
TOTAL
0...,173,174,175,176,177,178,179,180,181,182 184,185,186
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