FAX ORDER FORM

FAX ORDER FORM Printer Friendly Version
If you need assistance identifying part numbers, please call our Parts Department at 813-677-6642 or (863) 686-8744.

GRAPHIC ORIENTED SERVICES, INC.
	Billing Information	Shipping Information (if different from Billing)
Company Name:
Contact:
Address:
City, State, Zip:
Telephone:
Fax:
Email Address:

Equipment & Model # _______________________________________ Serial # _________________ (recommended)

PARTS ORDER
Qty	Part #	Description








1		Florida Sales Tax
1		Shipping & Handling

Credit Card Information
We accept Visa® and MasterCard©	□ MasterCard ©	□ Visa ©
Card Number (16 digits)	_______ - _______ - _______ - _______
Card Expiration Date	___ /___ (MM/YY)
Cardholder's Name
Company Name on Card
Billing Address for Credit Card
Zip Code
3-digit Card Code Found on Signature line of Card
Cardholder's Signature

Specify Requested Shipping
□ UPS Ground	□ UPS 2nd Day-Blue Label	□ UPS Next Day-Red Label

Please fax this Order Form to our Parts Department at 813-677-3891 or 863-686-7278 E-Mail: graphicoriented@tampabay.rr.com