National Cleaning Systems -  Fax Order Form
Fax: (954) 785-8768
Please Include your email address so we can contact you to approve the order.

           B i l l   T o :

Company Name         

                                                       

Your Name

Street Address 

City

State

Zipcode

Fax No.

Phone No.   

              S h i p   T o :

Company Name     

                                                           

Attention

Complete Street Address (No PO Boxes Please)

City

State

Zipcode

Fax No.

Phone No.   

Item No.  

Color

Description

 Unit
Qty

Cost
Unit

Extended Cost

     

     

     

     

     

     

     

     

     

     

     

     

           
           
           

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

Merchandise Total 

$

 

Payment Information:     

BankCard(Name)_____________________

Bank Card #________________________________________________________________ Exp__________

Signature ______________________________________________________________________

You will receive an order summary via email. Check and approve the summary which will have your shipping cost information. As soon as we receive your approval reply, we will process the order. We will email you a confirmation when your credit information is verified.

*Note: Since fax orders need hand entered confirmation, it will not be instant like online ordering. At times, the confirmation emails will be limited to normal business hours.