We sell, buy, rent, repair and refurbish used barcode equipment

Ordered by: (Company/Person)

Email Address

Phone (Optional)

(###)

###

####

PO process date (You can leave blank if it is today)

YYYY

PO# (Optional)

Ship to Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Bill to Address (Leave blank if the same)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Shipping Method

Account Number (Optional)

Do not have a shipper account number, please charge shipping cost to invoice

Payment Method

Item #1 Description/Part Number

Item #1 Quantity

Item #1 Price

Item #2 Description/Part Number

Item #2 Quantity

Item #2 Price

Item #3 Description/Part Number

Item #3 Quantity

Item #3 Price

Item #4 Description/Part Number

Item #4 Quantity

Item #4 Price

Notes (If needed input additional items here)

By checking this box you agree that you have signed this PO electronically

Yes I agree to the e-signature option