WHOLESALE FORM
Commercial Accounts Only

ORDER    REQUEST FOR PRICE      (Check One)

We require you enter both Item Number and Name to help avoid ordering errors.

Purchase Order number (if applicable)

PROD # PRODUCT NAME QTY Select Unit
Wholesale Cost
Do NOT include shipping in your total      TOTAL 
All orders are subject to acceptance by Reiner Products, Ltd. in accordance with our "Terms of Sale" regardless of the form in which submitted.
Truck and UPS shipments are from zip code 06706.
All orders, unless otherwise specified are shipped F.O.B. Waterbury, Ct.  06706

BUYER'S INFORMATION

* indicates required information

 
Company Name
*
Customer Name
*
Street Address
*
Post Office Box (if Applicable)

City
*
State
*
Zip Code   +4
*
Telephone            Extension
*  
Fax

E-mail
*
State Resale Number (New Accounts)

SHIPPING ADDRESS

(if different than above)

 
Ship To:

Ship Attention of:

Street Address

Post Office Box (if Applicable)

City

State

Zip Code +4
If you need to send additional information or instructions with your order, enter in box below then submit your order.
 

 

 

Thank you for selecting Reiner Products!

JR
Copyright © 1999 Reiner Products, Ltd.  All rights reserved.
Rev. 04/08/09 09:01