Uninterruptible Power Products, Inc.

ORDER FORM

Date:
Account #:		Quote #:
BILL TO :
Name:		Address:
City:		State/Prov.:
Zip/Postal:		Country:
Contact Name:		Email:
Phone:		Fax #:
SHIP TO: (if different)
Name:		Address:
City:		State/Prov.:
Zip/Postal:		Country:
Phone:		Email:
P.O. #		Requested Delivery Date:

Line #	Qty Ordered	Part #	Description	Unit Price	Total Price
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Payment Options

Terms: All net orders must have approved credit. Click HERE for Credit Application form
How will you be making payment?($U.S. Dollars)
Open account, with approved credit!
Cash in Advance
Credit Card Information
MC/Visa/AMEX (card on record) or
Full Name:
Credit Card #: Exp Date:

Shipping Information

Please sent products via:

Your UPS #: Your FEDEX #:
If other please state: Sorry, No COD

Additional Information to assist us in your request:


	Uninterruptible Power Products, Inc. 1567 W. 11th Drive Friendship, WI 53934 608.339.2151 800.832.7709 Fax:800.545.7623 www.uppi-ups.com