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Model RWSS Order Form

Ref: State of MN Contract #425305. Release No: T-644(5)

Customer Name:

 

Shipping Address 1: 

 

Shipping Address 2:

 

Attention:

 

Billing Address 1:

 

Billing Address 2:

 

City:

 

State:

 

Zip Code:

 

Phone Number:

 

Fax Number:

 

E-mail Address:

 

Billing Contact:

 

Purchase Order Number:

 

RWSS Order Quantity:

 

Comments/Special Instructions:

 

Unless specified, all orders will ship via UPS regular Ground Delivery.  Charges for shipping will be added to the invoice total.  MN State Sales Tax applies to product and delivery charges, and will be added to invoice total.  You must be an active member of the State of MN Cooperative Purchasing Venture, to take advantage of this contract.

 
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