Rimtec Corporation - Product Order Form


PRODUCT ORDER FORM All inquiries and sales orders are routed to the appropriate local sales organization. Please complete all fields to allow us to process your order promptly.

Please Select:	Existing Customer
	New Customer (Please include or fax credit references)
Contact Name:
Job Title:
Company Name:
Industry:
Address:
Address (cont.):
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:
Email:
How did you hear about Rimtec?

Order Information

Rimtec Quote # (if available):

Order Code	Qty.	Date Needed

Bore 1	Bore 2	Length

Standard keyways?	Yes \| No
If no, please specify
Special instructions?

Add additional products here or skip to the next section of the form.
Order Code	Qty.	Date Needed

Bore 1	Bore 2	Length

Standard keyways?	Yes \| No
If no, please specify
Special instructions?


Order Code	Qty.	Date Needed

Bore 1	Bore 2	Length

Standard keyways?	Yes \| No
If no, please specify
Special instructions?


Order Code	Qty.	Date Needed

Bore 1	Bore 2	Length

Standard keyways?	Yes \| No
If no, please specify
Special instructions?

Payment Information
Rimtec now accepts payment via major credit card or purchase order. Please indicate desired payment method below. A Rimtec sales associate will contact you to confirm your order.
Credit Card	Visa MC AX Discover
Purchase Order	Enter PO #

Shipping Instructions
Rimtec ships UPS ground unless otherwise specified.
Special instructions?
Tag info (if applicable)


Ship To:	Use address listed above
Company Name:
Address:
Address (cont.):
City:
State/Providence:
Zip/Postal Code:
Country:


Bill To:	Use address listed above
Company Name:
Address:
Address (cont.):
City:
State/Providence:
Zip/Postal Code:
Country:

Copyright © 1999-2004 Rimtec Corporation, 211 S. Lombard Road, Addison, IL 60101
Toll Free: 877-4RIMTEC (877-474-6832) ~ Phone: 630-628-0036
Fax: 630-628-0041 ~ Email: info@RimtecCorporation.com
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