JLT Order Form for Parts and/or Machines

JLT ORDER FORM FOR PARTS AND/OR MACHINES

* All orders emailed will be processed on the next business day.
* An order confirmation will be sent via email to reflect ship date and purchase total.
* All Credit Card numbers are kept completely confidential and can only be processed with expressed consent.

SOLD TO
Company Name:
Email Address:
Contact Name:
Phone Number:
Address:
City:
State:
Zip Code:

SHIP TO
Company Name:
Address:
City:
State:
Zip Code:

Purchase Order #:
Credit Card:	Visa Mastercard American Express Discover
Credit Card Number:
Expiration Date:	Month Year

**If you would like to pay by check - Please check here and JLT will send you an order invoice for payment. ALL orders are CIA. JLT will ship your order the day we receive full payment via company check, wire transfer or bank check.

SHIPPING INSTRUCTIONS
Parts:
UPS Ground UPS 3 Day Select UPS 2nd Day Air UPS Next Day Air UPS COD Customer Pickup
Machines:	JLT Preferred - LTL Truck Carrier is Estes Express (we will provide via email exact freight charges on your order prior to shipping) Estes Prepaid & Add	Estes Collect

Quantity Part Name/Model:
Part/Machine Description:
List Price:
Ordered By :
Date:
Additional comments or info: