Parts Order Form
Fax to:
Optimus Fax No. 901-794-3884
Company Name________________________________________ Date___________________
Address______________________________________________

Phone__________________
City, State, Zip_________________________________________ Fax____________________
Order Placed by___________________ PO No_______________ Opt. Cust No.____________
Ship Via:
UPS Ground
2nd Day Air
Overnight Air
_________________

3rd party shippers assumes all responsibilty for filing lost or damaged claims.
Carrier ancillary charges will be billed to you
Ground Freight Prepaid on orders of $500 Net or more
We will ship any order regardless of size (However, a $5.25 minimum order fee will apply for any order under $20 after all discounts.)
All orders over $20.00 are charged a $2.50 fee. Stock items ordered by 1:30 PM central time are shipped same day.
Payment Via:
COD(UPS adds $9.00)
We have Approved Credit
Credit Card
Card Type__________
 Card No.___________________
exp date_______
Qty. Optimus No. Description
     
     
     
     
     
     
     
     
     
     
Do NOT Ship Partial Order
Ship Order Complete Only
Comments & Special Instructions:
Different "Ship To" Address
(UPS adds an additional & 2.40 for residentual delivery)
__________________________________________

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You MUST fill out all of top header information, then quantity, and Optimus Item Number!